History of electroconvulsive therapy in the United Kingdom

Electroconvulsive therapy (ECT, in the past sometimes called electric convulsion therapy, convulsion treatment or electroplexy) is a controversial psychiatric treatment in which seizures are induced with electricity. ECT was first used in the United Kingdom in 1939 and, although its use has been declining for several decades, it was still given to about 11,000 people a year in the early 2000s.

In contemporary psychiatric practice, ECT is used mainly in the treatment of depression. It is occasionally used in the treatment of other disorders such as schizophrenia. When undergoing modern ECT, a patient is given an anaesthetic and a muscle relaxant. A brief-pulse electric current of about 800 milliamperes is passed between two electrodes on the head for several seconds, causing a seizure. The resulting convulsion is modified by the muscle relaxant. ECT is usually given on an inpatient basis; about one in five treatments are given on an outpatient basis. Treatment is usually given twice a week (occasionally three times a week) for a total of 6–12 treatments, although courses may be longer or shorter. About 70 per cent of ECT patients are women. About 1,500 ECT patients a year in the UK are treated without their consent under the Mental Health Acts or the provisions of common law.

ECT was invented in Italy in 1938. In 1939 it was brought to England and replaced cardiazol (metrazol) as the preferred method of inducing seizures in convulsion therapy in British mental hospitals. Although soon established as especially useful in the treatment of depression, it was also used on people with a wide variety of mental disorders. There was large variation in the amount of ECT used between different hospitals. As well as being used therapeutically, ECT was used to control the behaviour of patients. Originally given in unmodified form (without anaesthetics and muscle relaxants) hospitals gradually switched to using modified ECT, a process that was accelerated by a famous legal case.

ECT originated as a new form of convulsive therapy, rather than as a completely new treatment. Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J Meduna who, believing that schizophrenia and epilepsy were antagonistic disorders, induced seizures in patients with first camphor and then cardiazol.

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