In the years 2006 and 2007 the rates of usage of ECT in Edinburgh were only 0.82 and 0.88 patients per 10 000 total population. This is approximately a third less than the rate in 2005, and three-quarters less than the rate in 1993
For comparison in Belgium in 2000, the ECT rate was 4.8/10,000 inhabitants. By 2006 it had increased to 6.6/10,000 inhabitants. In Spain in 2007 the ECT rate, measured in patients per 10,000 inhabitants, was 0.61. In Portugal in 2007 the ECT-rate was 0.5-1.2/10.000 inhabitants. In The Netherlands in 2000 it was 0.22 per 10.000 inhabitants
The authors suggest that this might be due to the ECT guideline by the NICE. The guideline published in 2003 was very restrictive in indicating ECT. This guideline was controversial and the Royal College of Psychiatrists subsequently published its own ECT guideline.
The other suggestion that ECT is less needed because of all the other therapies available for treatment of depression is to my opinion nonsense. The authors cite the STAR*D trials to oppose this notion with which I can fully agree. Even after four treatments only 67% of patients remitted from their depression.
I fear less patients with severe depression get the right treatment. It also has implications for clinical research, psychiatric ECT clinics have to join forces in order to be able to do future research with ECT. These are the worries of ECT researchers in Edinburgh with a long and excellent history of ECT research.
I will be in Edinburgh on October 8th attending a meeting of the Scottish ECT Accreditation Network (SEAN) with a Dutch delegation. Will ask them about this development and their opinions there on, will let you know.
Scott, A.I., Fraser, T. (2008). Decreased usage of electroconvulsive therapy: implications. The British Journal of Psychiatry, 192(6), 476-476. DOI: 10.1192/bjp.192.6.476