Dr. Kolar writes that “ECT is one of the most controversial treatments in medicine, particularly because of the still unknown mechanism of action and uncertainty about cognitive side effects.”
Researchers, including Dr. Kolar, found that patients routinely receive inadequate informed consent that does not mention the risk of permanent impairment. For instance, the consent forms provided by the licensing body, the American Psychiatric Association (APA), state that “Most patients report that memory is actually improved by ECT.” But researchers say that statement “is contradicted by all service-user research” as well as many findings in the research literature. The researchers identified that over a third of patients experience permanent memory loss. This contradiction may account for why they also found that “Half of people given ECT say they did not receive an adequate explanation of the treatment.”
In recent years, doctors have attempted to mitigate the possibility of memory loss and cognitive impairment by modifying the ECT technique (for instance, stimulating only one side of the brain at a time). However, these findings indicate that the treatment still carries considerable risk. Additionally, these modifications tend to make the treatment far less effective, further skewing the risk/benefit ratio.
Dr. Kolar acknowledges the utility of ECT for certain populations but suggests that the risks of the treatment have been minimized. He writes, “There is no doubt that ECT is effective and life-saving for a selected population of patients. However, a good balance of sustained benefits and possible risks or serious cognitive side effects is not always reached.”
He suggests that better tools for assessing memory loss and cognitive impairment need to be used throughout the course of treatment, and that informed consent practices need to be updated to include the very real risk of permanent side effects.