New TCD Research Shows Use of ECT in Ireland is Much Less Varied than Previously Believed
Posted on: 19 April 2011
A new study by Trinity College Dublin researchers shows that the use of electroconvulsive therapy (ECT) for depression in Ireland is substantially less varied than previously believed. The findings were published this month in the Irish Medical Journal. The research was supported by funding from the Health Research Board in Ireland. TCD researchers Dr Ross Dunne and Professor Declan McLoughlin, of the Department of Psychiatry and Trinity College Institute of Neuroscience, are co-authors of the study.
ECT is the most powerful treatment available for depression. Modern treatment involves applying a small electrical charge to the brain of an anaesthetised patient under medically controlled safe conditions. Repeated treatments induce several molecular and cellular changes in the brain that are believed to be important for its antidepressant mechanism of action. About 450 people are treated annually with ECT in Ireland and about 1 million worldwide. The most common indication is for severe depression that has proven resistant to antidepressant drugs and psychotherapies. ECT can be a life-saving treatment for people with catatonia and those who are actively suicidal or physically debilitated by depression.
Commenting on the findings TCD Research Professor of Psychiatry, Declan McLoughlin, said: “ECT is undoubtedly a highly clinically effective treatment but, unfortunately, its use has been limited by stigma as well as public concerns about previously reported variability in its use throughout Ireland. The Mental Health Commission (MHC) has taken an international lead in their annual reporting on ECT in approved centres in Ireland. However, in some of its analyses, the Report does not take into account where patients normally live and also excludes those Irish patients treated in the independent sector, which provides a pan-national service. It, therefore, cannot provide the full picture.
To address this, 2008 data from the Mental Health Commission and the Health Research Board (HRB) was combined to compare the use of ECT between the four different HSE administrative regions. Following the inclusion of data from the independent sector, the researchers found that inter-regional variation was more than halved; the remaining variation was mainly due to higher use of ECT in the West region, though the most recent MHC Report indicates that this is probably beginning to even out.
The research also found that prescribing of ECT in Ireland (9.6 per 100,000 population) was not different to that in other European and North American countries. Rates of use of ECT in the Irish university teaching hospitals were similar and, again, were comparable to international centres.”
Co-author of the study, Dr Ross Dunne, said: “Our findings have immediate clinical relevance and will help Irish people with severe depression, their families and clinicians to make better-informed treatment decisions about ECT. Of note, nearly half of the Irish centres provided a very limited ECT service, treating less than 10 patients in 2008. In line with recent developments in other branches of Irish medicine, we, therefore, recommend that regional and national ‘centres of excellence’ for ECT be established to concentrate expertise and maintain best practice.”