Dr. William Narrow on ECT
Dr. William Narrow presented to the U.S. Food and Drug Administration Neurological Devices Panel examining the reclassification of electroconvulsive therapy (ECT) devices on January 27, 2011. These are his remarks as published in the public record of the meeting.
My name is William Narrow. I’ve been a board certified psychiatrist for 20 years and currently serve as the Associate Director for the Division of Research at the American Psychiatric Association. Thank you all for the opportunity to speak on behalf of the APA regarding the safety and efficacy of electroconvulsive therapy and to address FDA’s classification of medical devices used for ECT.
Before I begin my remarks, let me say that neither I nor the American Psychiatric Association is involved in the manufacture or sale of ECT devices.
ECT is an important treatment option for psychiatrists. It is most often used to treat psychiatric illness in three situations: when rapid, definitive treatment is needed to prevent harm to the patient, when other treatment options present unacceptable risks, or when a patient has a previous history of poor medication response or a good response to ECT.
ECT is most often used to treat severe symptoms of three mental disorders, major depressive disorder, schizophrenia, and bipolar disorder. All of these disorders can be manifested in life-threatening ways, including profound and intractable suicidal intent, catatonia that can lead to complications such as dehydration, starvation, and venous thrombosis, and manic episodes that can lead to lack of self care, destructive behavior, and physical exhaustion.
The availability of ECT assures rapid, safe, and effective treatment for the manifestations of severe mental disorders. In many cases, it is lifesaving. A large body of evidence published in peer-reviewed medical journals has documented the safety and efficacy of ECT.
Much of the public stigma attached to ECT is based on lurid media depictions of early treatments in which high doses of electricity were administered without anesthesia for any number of psychiatric problems or simply for punishment. Modern ECT is nothing like these portrayals.
The American Psychiatric Association has developed recommendations for ECT treatments, training, and privileging. These recommendations state that ECT should be administered by a team of trained health professionals with experience in ECT administration, including a trained ECT psychiatrist, an anesthesia provider, and one or more nurses. The electrical stimulus is given while the patient is under light general anesthesia with muscle relaxation. The seizure, initiated by the electrical stimulus, is monitored by EEG. After the procedure, the patient is monitored by a registered nurse as is done for any procedure involving general anesthesia. Although ECT causes side effects, it uses electrical currents given in a controlled setting to achieve the most benefit with the fewest possible risks.