Recently I spoke with someone who had, in the past, been given a large number of electroconvulsive therapy (ECT) treatments. This person thought that the treatment had helped, but that their memory had been permanently affected. I listened reluctantly, thinking of all the other reasons there might be for that – illness, age, medications. It’s easy to blame ECT for difficulties that might have happened anyway. Later, I let myself think about it, knowing that the reason for my unease was that I, too, had undergone a similar number of ECT treatments. As a psychiatrist, I know that ECT is a rapid and lifesaving treatment in severe depression, when the patient is suicidal, or no longer able to care for themselves. The worse the illness, the better it seems to work, and it can be miraculous. We have all seen patients who are barely communicating transformed by even one or two treatments: eating and talking, and freed of the burden of suffering. It was like that for me. I have had courses over the years to treat psychotic depression, initially when I was pregnant with my first child, and most recently three years ago. In total, I have had around 70 individual treatments. Without it, I’m not sure I would have recovered to be with family or train as a psychiatrist. I will have it again, if I need to. I think it is a good treatment, but I think it comes with its fair share of problems, which can be unduly minimised by clinicians. This is understandable: as a doctor, you want your patient to have the best treatment for their condition, and finding the words to describe ECT and its adverse effects is hard. Even the basics – an electric current will be passed through your brain, causing you to have a seizure – are terrifying. But the experience itself was, for me, very easy. You get a short general anaesthetic so that you are completely unaware of the seizure, which is, in any case, almost imperceptible due to a muscle relaxant. You wake up, a bit confused, and when that settles, you’re done. During my last course, I experienced this twice-weekly for seven weeks. From feeling entirely hopeless about the future, my mood lifted with each session. This was initially more obvious to others than to me; it took some months for me to feel myself, but the severity of my depression reduced within weeks. Life was worth living. Views about ECT are polarised. There is good evidence that it works and is safe, although medication is usually needed to maintain long-term remission. But there are people who have been treated with ECT who consider that they have been permanently damaged by it. As a doctor and psychiatrist, I know that all treatments will have potential unwanted effects, and it would be wrong to say that such problems are not possible. But we mustn’t forget that the illnesses that require ECT are horrible, and might also cause damage if left untreated. Personally, I don’t believe that I am cognitively impaired, although it’s hard to prove. But I have maintained a challenging career and taken postgraduate degrees, and that makes me feel better. But I have felt the downsides of ECT, in a couple of ways, and I can see the dangers of being too reassuring about it. My memory was significantly affected, each time. A junior doctor told me recently that they were taught that memory problems were unusual and short-lived. But I’ve talked to quite a few others who have had ECT, and they all experienced memory issues. Some may welcome this at a time of great distress and suffering. For me, it’s as though there are big holes in my memory before and during a course of treatment. My daughter was a baby when I first had it, and I’ve lost a lot of her first two years, during which I had a number of courses. I also have no memory, ever, of having consented to treatment. I know I did, but perhaps this is a process that should be repeated? Reminders and reassurance can go a long way. Even more disconcerting is the feeling of discombobulation – it’s like looking back at a dream period, where you’re not entirely sure what really happened, and I find this troubling. It does improve, in that my ability to lay down memories quickly returns once treatment stops, but there will always be a period of months that is loosened and distorted. It doesn’t come back, not properly, and can leave you feeling not quite sure who you are. The other problem is stigmatisation. It’s fairly acceptable to admit to taking antidepressants these days, less so ECT. That terrible portrayal in One Flew Over the Cuckoo’s Nest has a lot to answer for, and it probably does pop into people’s minds, even though it’s far from the truth. But the other thing I find hard is that those who oppose ECT can be vituperative, accusing clinicians and others of deliberate attempts to harm. It is very unsettling; when I read their comments, I do find myself worrying that I may yet develop further brain disease. They spread fear and hurt, and it doesn’t help anyone. It’s not just one-way though; clinicians who dismiss or minimise adverse effects too glibly don’t help either, and each provokes the other. There are no goods and bads with ECT, no rights or wrongs. The decisions should be clinical, not moral. As a clinician, I am satisfied that it’s a very good treatment, but I will never be complacent. As a patient, I feel the same. What I do want is more acknowledgment of the memory problems and associated distress, and more support for people going through treatment. Until we have another better treatment that works rapidly, I think there will be a place for ECT. For most people, the problems will be tolerable if well explained and monitored. And that’s the key. Being upfront about the downsides builds trust. By exploring those things together, the patient will feel reassured, and the doctor will have done their duty. As doctors, we have a duty to explain, and patients have a right to knowledge and reassurance. Rebecca Lawrence is a consultant psychiatrist In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978