Sir

Peter Sterling1 criticizes the reviewer of my book2 for stating that electroconvulsive therapy (ECT) is both safe and effective in treating the severely mentally ill3. Using the example of a friend who, a year after having ECT, complained of “huge gaps in recall of major life events”, he argues that history will view ECT as another “great and desperate cure” akin to psychosurgery.

Sterling errs on many counts, the principal one being his reliance on images of ECT from half a century ago. Despite Sterling's assertion, electric currents are not inherently dangerous just because touching an open electric socket is painful. For example, they are widely used to slow a racing heart. In ECT, because of the resistance of skin, bone and galea, very little of the energy gets to brain tissue; indeed, modern technique calls for the determination of the minimum current needed to elicit a seizure.

Scientists have sought evidence of brain damage for half a century, using elaborate brain imaging methods and psychological tests in humans, and neuropathological studies in animals given high levels of currents or large numbers of seizures. No such evidence has emerged4.

Sterling is wrong when he argues that the cure for depression “requires this procedure to be repeated 10–20 times over a week or so”. Modern ECT resolves depression in four to eight sessions, spaced at two to three times a week, in more than 80 per cent of patients using optimal treatment methods. No study has found any other antidepressant treatment to be more effective than ECT5.

ECT has no semblance to stroke, and Sterling's comparison is unfounded. Again, contrary to Sterling's argument, studies of the functions of the non-dominant hemisphere fail to demonstrate persistent effects of unilateral ECT on both non-verbal and verbal testing5,6.

ECT was developed in the late 1930s, and by 1950 tests of memory function were part of our treatment schedule2,5. Such tests are routine today, and the literature on ECT and memory is extensive6. There are defects in memory associated with severe mental illnesses, and these defects are exaggerated during treatment with medications or ECT. But when patients recover from their illness, and from the immediate effects of ECT or medicines, they are as able to recall life events, to learn anew and to work effectively as age- and education-matched controls.

The benefits of ECT are temporary, but so are the benefits of psychiatric medications. These treatments must be continued for years to prevent relapse.