The use of ECT declines in the United Kingdom, what about the rest of Europe?

ECT electroshock

Compared to 1999 and 2002 data from a recent survey in 2006 show an overall decline in the number of ECT applications and the number of patients treated in the United Kingdom over the 7-year period between 1999 and 2006. An increasing proportion of patients were treated under the Mental Health Act (1983).

Clinical implications

The number of ECT clinics is likely to continue to decrease and psychiatrists may have decreasing experience of treating patients with ECT.

In The Netherlands there is an opposing trend. In the past decades the number of clinics preforming ECT has increased and the number of patients being treated also increased, but than the state of ECT was deplorable in the eighties of the previous century. In 1992 only 30 patients in 1 year were treated with ECT on a population of 13 million people. In 2000 it were around 300 patients a year. The restricted use of ECT in The Netherlands in those day was due to socio-political factors such as unfavourable public perception and professional attitude.

From a recent survey in The Netherlands (Journal of ECT, published ahead of print) (2008) of all Dutch facilities with mental health beds in 2008, all 8 university hospitals (100 %), 16 of 86 (19 %) general hospitals and 11 of 48 (23 %) psychiatric hospitals had an ECT service. The total amount of ECT sessions in the Netherlands was approximately 13,500 a year (8.5 sessions per 10,000 inhabitants). This is low compared with e.g. the 14 treatments per 10,000 in Scotland and the approximately 27 per 10,000 in the USA. However, use of ECT in the Netherlands has increased substantially since 1999, at which time it was only 1.8 per 10,000 inhabitants

For comparison in Belgium a recent nationwide survey among all the psychiatric services providing ECT revealed that in 2003-2004 ECT was performed in 32 psychiatric services (21.5% of all psychiatric services). ECT is available in 13.6% of psychiatric hospitals and 32.8% of general hospitals with a psychiatric department, but two thirds of these ECT facilities treat less than 2 patients per month. The annual rate of ECT use in Belgium is increasing. In 2000, the ECT rate was 4.8/10,000 inhabitants. By 2006 it had increased to 6.6/10,000 inhabitants. For more information from one of the experts of ECT in Belgium please see the blog: Electroconvulsive therapy

According to the University of Munich, the renaissance of ECT in Germany is still ongoing; from 1995 to 2002 the number of treatments in that hospital more than doubled. From personal communications we learned that in Portugal, in the past few years, a total of 6 ECT-units became active, 3 of which are situated in the Lisbon area (Lisbon, Amadora). These units performed a total of 500-1200 treatment sessions in 2007. This corresponds to an ECT-rate of 0.5-1.2/10.000 inhabitants. Data on the use of ECT in France and Spain are scarce or very limited.

Since recent the European Forum For Electroconvulsive Therapy EFFECT was founded. The mission of EFFECT is:

EFFECT aims to promote access to safe and effective ECT when appropriate for patients across Europe by promoting research into ECT, combating the stigma associated with ECT, educating and informing both mental health professionals and the general public about ECT and its use.

This seems to benefit the deplorable state of the use of ECT in some European countries. Now back to the UK. The authors of this publication of the survey stated the following reasons for the decline:

  • The National Institute for Health and Clinical Excellence (NICE) has recommended restricting its use to severe depression, catatonia or severe mania when other treatments have failed
  • Electroconvulsive therapy is under a process of centralisation and rationalisation, which may reflect the lower numbers of patients treated and a need to concentrate resources and local expertise in driving up standards
  • Availability of a greater variety of safe alternative antidepressants
  • Patient resistance
  • A reduction in in-patient bed numbers

Probably the amount of patients treated in the UK and the rest of Europe will meet somewhere in between. In the UK, ECT used to be frequently used, in the rest of Europe ECT was underutilized until recent. What do you think?

Related posts on this blog:

10 videos on ECT

Interview with Dr Shock on Electroshock

11 New Sites and Blogposts with Information about ECT
D. Bickerton, A. Worrall, R. Chaplin (2009). Trends in the administration of electroconvulsive therapy in England Psychiatric Bulletin, 33 (2), 61-63 DOI: 10.1192/pb.bp.107.019273

T. C. Baghai, A. Marcuse, H.-J. Möller, R. Rupprecht (2005). Elektrokonvulsionstherapie an der Klinik für Psychiatrie und Psychotherapie der Universität München Der Nervenarzt, 76 (5), 597-612 DOI: 10.1007/s00115-004-1813-5

P SIENAERT, M DIERICK, G DEGRAEVE, J PEUSKENS (2006). Electroconvulsive therapy in Belgium: A nationwide survey on the practice of electroconvulsive therapy Journal of Affective Disorders, 90 (1), 67-71 DOI: 10.1016/j.jad.2005.09.016