Malcolm Peet

Antidepressant drug treatment in relation to the use of ECT

The adequacy of antidepressant treatment by psychiatrists prior to ECT was examined in a group of 95 patients. ECT was considered inevitable in 16 cases. Of the remainder, 41 patients had not been given adequate antidepressant treatment prior to ECT. Alternative drug strategies were seldom pursued after one drug had failed. Most patients were continued on a variety of psychotropic drugs during ECT. Subsequent outcome was poor, which may reflect difficulty in identifying an appropriate drug for continuation treatment after ECT.

The use of electroconvulsive therapy in elderly depressive patients

Though widely used and extensively investigated, electroconvulsive therapy (ECT) remains a controversial treatment. Attitudes to ECT amongst doctors and patients tend to be polarized. Extreme antagonists refer to ECT as ‘electrocution’ and regard it as a primitive blunderbuss treatment which causes brain damage. This attitude is commoner amongst recipients of ECT than amongst psychiatrists. At the other extreme is the view, held more commonly by psychiatrists than their patients, that ECT is dramatically effective and the treatment of choice in severe depressive illness. These polarized attitudes have led to attempts on the one hand to ban ECT, and on the other hand to the indiscriminate and uncritical overuse of ECT.