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"Convulsive therapy in developing countries"
- K.A.L.A. Kuruppuarachchi (18 August 2009)
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K.A.L.A. Kuruppuarachchi, Professor of Psychiatry Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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lalithkuruppu{at}lycos.com K.A.L.A. Kuruppuarachchi
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The Editorial on Convulsive therapy turns 75 by Gazdag et al (BJP 2009) has been read with interest. Obviously invention of “ CONVULSIVE THERAPY” by Meduna is a great achievement and a revolution in world psychiatry. Even though the practice was very crude initially well modified ECT is administered worldwide without major problems at present. Many developing countries seem to have a liberal policy in administering ECT when compared with the developed world due to various reasons such as need for a quick response and turnover, less social pressure against this therapy, medical profession’s flexible attitude towards ECT etc. Patients and relatives also depend more on the therapists to make the decision about the ECT than in the west and they appear reluctant to displease the therapists and many patients do not seem to bother much about side effects such as headaches, memory problems. It is interesting to note that the standard of the practice of ECT has been improving in many developing countries. For instance in Sri Lanka the quality of the electroconvulsive therapy has improved significantly over the last few decades and which will continue to improve. About 30-40 ECTs without much modification were administered almost every other day in large mental hospitals situated in suburbs of Colombo, Sri Lanka a few decades ago. Also “insulin coma therapy” was practiced several decades ago by some psychiatrists, which has only a historical importance at present. The things have been improved to a considerable extent and well modified ECT under anaesthesia by using Thymatron machines is administered in almost all the units. Consent forms are incorporated and educational leaflets are given to patients in many units. It has been reported that ECT is widely practiced in India even more than in the west and administered for similar conditions with similar results as in the west. However the method of administration may be different and many may not receive the modified ECT (Trivedi 2002). Even in our part of the world indications are getting narrower and ECT is mainly considered for severe forms of depressive disorder and catatonia(which is still encountered). In the management of depressive disorder many clinicians seem to continue the antidepressants with the ECT, which is usually commenced prior to or simultaneously with the ECT. A recent study demonstrated the enhanced efficacy of ECT and reduced cognitive adverse effects by adding antidepressants like nortriptyline whereas adding venlafaxine showed a weak response and tended to worsen cognitive side effects (Sackeim et al. 2009). It seems we need to do more research work in this area. Studies have also shown the improvement in the quality of life and function of patients after ECT(McCall 2004).Obviously in this therapy the benefits out weights the risks. Hence it is important that the clinicians get familiarized with and continue to practice this effective form of therapy globally. References; Gazdag G, Bitter I, Ungvari G.S, Baran B. Convulsive therapy turns 75. The British Journal of Psychiatry 2009; 194 : 387-388. Trivedi J.K. Pracitice Of ECT In India. Indian Journal of Psychiatry 2002; 44(4): 313-314. Sackeim H.A, Dillingham E.M, Prudic J, Cooper T, McCall W.V. et al Effect of Concomitant Pharmacotherapy on Electroconvulsive Therapy Outcomes, Short-term Efficacy and Adverse Effects. Archives of General Psychiatry 2009; 66(7): 729-737. McCall W.V, Dunn A, Rosenquist P.B. Quality of life and function after electroconvulsive therapy. The British Journal of Psychiatry 2004; 185: 405-409. |
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