, 1
Chapter
The Place of ECT and Related
Treatments in Contemporary
UK Psychiatry
I Nicol Ferrier
The previous edition of The ECT Handbook was produced in 2013 and was well
received. The current edition updates the 2013 one and attempts to find a similar
balance between outlining the scientific literature relating to ECT and related
treatment modalities and pragmatic and practical advice on their place in
management and delivery in a UK context. This chapter concentrates on the
guidelines in the UK for the use of ECT and related treatments. The
recommendations of NICE for the use of ECT and related treatments are outlined
first, followed by position statements from the Committee. Any differences (which are
usually minor and of emphasis rather than substance) are highlighted. The position
statements were generated in 2017 and have been ratified by the College. They can be
found on the Royal College of Psychiatrists’ website at:
www.rcpsych.ac.uk/workinpsychiatry/committeesofcouncil/ectandrelatedtreatments.aspx
Evidence supporting these position statements can be found in individual chapters
of the Handbook.
The use of ECT has fallen across the UK in the last few decades although there is
some evidence that, in the last few years, the numbers of courses administered each
year is falling much more slowly (Buley et al., 2017; SEAN, 2016). There are a myriad
of reasons why the numbers of patients receiving ECT have fallen: some relate to
attitudes of patients and of staff, others relate to the problems of delivering it in the
current service framework. These issues are discussed more fully in subsequent
chapters of this Handbook. Paradox- ically the evidence base for the efficacy and safety
of ECT continues to grow. The Committee feels that it is a valuable treatment that is
either not considered at all or left until too late, in the management of many complex
and severe cases. The position statement relating to ECT outlines the kind of patients
for whom the College believes ECT should be considered. Despite the strong evidence
for ECT, it is likely it will continue to be used only for a minority of patients with
complex and severe mental illnesses so it is gratifying, given the scale of the clinical
problem, that research on other potential physical treatment modalities for some of
these patients is active. The position statements, together with the relevant National
Institute for Health and Care Excellence (NICE) guideline recommendations, on ECT
and the most prominent related treatments are given below, focusing on their use in
depression. There are a variety of international guidelines on ECT and other modalities
Chapter
The Place of ECT and Related
Treatments in Contemporary
UK Psychiatry
I Nicol Ferrier
The previous edition of The ECT Handbook was produced in 2013 and was well
received. The current edition updates the 2013 one and attempts to find a similar
balance between outlining the scientific literature relating to ECT and related
treatment modalities and pragmatic and practical advice on their place in
management and delivery in a UK context. This chapter concentrates on the
guidelines in the UK for the use of ECT and related treatments. The
recommendations of NICE for the use of ECT and related treatments are outlined
first, followed by position statements from the Committee. Any differences (which are
usually minor and of emphasis rather than substance) are highlighted. The position
statements were generated in 2017 and have been ratified by the College. They can be
found on the Royal College of Psychiatrists’ website at:
www.rcpsych.ac.uk/workinpsychiatry/committeesofcouncil/ectandrelatedtreatments.aspx
Evidence supporting these position statements can be found in individual chapters
of the Handbook.
The use of ECT has fallen across the UK in the last few decades although there is
some evidence that, in the last few years, the numbers of courses administered each
year is falling much more slowly (Buley et al., 2017; SEAN, 2016). There are a myriad
of reasons why the numbers of patients receiving ECT have fallen: some relate to
attitudes of patients and of staff, others relate to the problems of delivering it in the
current service framework. These issues are discussed more fully in subsequent
chapters of this Handbook. Paradox- ically the evidence base for the efficacy and safety
of ECT continues to grow. The Committee feels that it is a valuable treatment that is
either not considered at all or left until too late, in the management of many complex
and severe cases. The position statement relating to ECT outlines the kind of patients
for whom the College believes ECT should be considered. Despite the strong evidence
for ECT, it is likely it will continue to be used only for a minority of patients with
complex and severe mental illnesses so it is gratifying, given the scale of the clinical
problem, that research on other potential physical treatment modalities for some of
these patients is active. The position statements, together with the relevant National
Institute for Health and Care Excellence (NICE) guideline recommendations, on ECT
and the most prominent related treatments are given below, focusing on their use in
depression. There are a variety of international guidelines on ECT and other modalities
