Posted at 1:00 PM
As CHUM psychiatrists and researchers, we read with interest the article published in The press on May 7 on electroconvulsive therapy (ECT)1† We therefore allow ourselves to contribute to the debate.
From the outset, it seems necessary to state that we strongly believe that these kinds of statements from people with experience with mental disorders are essential to advancing the understanding and treatment of these disorders. ECT, invented nearly 85 years ago, has made significant progress over the past four decades and is sometimes still the last hope for some people who suffer from serious mental disorders. As confirmed by numerous scientific studies, ECT is now safer, generally well tolerated and has proven to be a highly effective therapy in cases of severe refractory depression.
Certain metrics presented in the article also seem to put us in better context. In particular, ECTs are expected to be administered more to older people, given the natural evolution of major depression, which can become more complicated with age (longer, more severe, and more refractory episodes over time). In addition, we can expect a certain over-representation of women in ECT, as twice as many of them suffer from depression as men, regardless of their culture.2
Although the cognitive impairments caused by this treatment resolve in the vast majority of cases3 and that many people even see their memory improve4we understand the concerns of ECT.
Also note the stigma still associated with this type of intervention, which adds to the heavy burden already borne by people with mental illness.
We believe that one of the most effective ways to respect the autonomy and preferences of these people is to continue to develop new treatment options for intractable depression.
In a specialized center such as the CHUM (where we do not offer ECT), transcranial magnetic stimulation (TMS) has been offered for about 15 years. It is an effective, non-invasive, safe treatment with few or no side effects, requires no anesthesia, and causes no adverse cognitive effects (on the contrary, several studies support the procognition of MSD). Although the TMS has been around for 25 years, it is still unknown to the general public. Our vagus nerve stimulation program (essentially a pacemaker for depression) may be a solution for patients who responded well to ECT but relapsed afterwards. Finally, psychedelics such as ketamine and psilocybin represent another potential therapeutic axis under study.
When combined with existing psychotherapeutic approaches and medications, all of which are known to be effective, treatment options are finally expanding.
It is important to destigmatize mental disorders and associated treatments. If society is to embrace this openly expressed desire that it wants the best for people with mental health problems, their concerns must be listened to carefully and their perspectives respected.
While certain nuances seem necessary with regard to the information presented in the media about ECT, the research effort should continue to reduce the side effects of current therapies and increase their effectiveness, while diversifying intervention options, reflecting preferences. and patient autonomy are respected. people who benefit from it.
†Jean-Philippe Miron is a psychiatrist and researcher at CHUM, assistant clinical professor in the Department of Psychiatry and Addiction Treatment at the University of Montreal Faculty of Medicine; Paul Lesperance is a psychiatrist and researcher at CHUM, professor in the Department of Psychiatry and Addiction Care in the Faculty of Medicine at the University of Montreal; Didier Jutras-Aswad is a psychiatrist and researcher and chief of the department of psychiatry at the CHUM, an associate professor in the department of psychiatry and addiction treatment at the Faculty of Medicine at the University of Montreal.