Blog: New NICE Guidelines for ECT are dangerously inadequate, say 50 patients and professionals

John Read and Chris Harrop

Electroconvulsive therapy (ECT) is still given to approximately 2,500 people in England annually, predominantly women and older people. A course of ECT consists of 6-12 sessions in which an electric current is applied to the brain, causing a seizure. NICE Guidelines in 2003 noted that there was very limited evidence for the effectiveness or safety of this procedure, and made an urgent call for more research. A 2019 review of the literature confirmed the lack of evidence justifying the use of ECT:

For an interview with the reviews’ authors see:

26 MPs in the UK, including the shadow minister for Mental Health, Dr Rosena Allin-Khan, have called for an independent enquiry into the practice and regulation of ECT. 

A 2021 audit of ECT use in England found multiple failings, putting patient safety at risk:

Another audit found that ECT information leaflets used by the NHS and the Royal College of Psychiatry were misleading patients by minimising risks and exaggerating benefits:

The recently published draft NICE Guidelines for Depression in Adults revisited ECT along with their other recommendations. However, none of the serious concerns NICE raised about ECT in 2003, or identified in the two recent audits, has been addressed. Consultation on the draft closed on January 12,

Therefore, an open letter from 50 people, including 18 ECT patients and relatives, 12 Psychiatrists and 7 Professors (attached) has been sent to NICE, and the government, calling for the ECT section of the draft guidelines to be ‘radically rewritten’ to avoid putting patients’ safety at risk. The letter can be read here:

The letter lists the ten most important flaws in the draft guidance: 

  • Abandoning the call for robust research into effectiveness and safety made by NICE in 2003 and reiterated in 2009 and 2014 
  • Abandoning NICE 2003’s call to establish safe dosages and consistent practice   
  • No statement about the need for regular testing for adverse cognitive/memory effects 
  • No recommendations on the provision of rehabilitation and compensation for memory loss/brain damage 
  • No comment on the huge regional variation in usage (up to 47-fold between different Trusts) 
  • Failure to address NICE 2003’s concern that many people are unaware of their rights and may be subject to coercion to have ECT
  • Failure to address NICE 2003’s concern that the research ‘did not adequately capture the experience of service users’who often felt that effects such as memory loss outweighed the benefits
  • Failure to reiterate important limitations on the recommended uses of ECT cited in NICE 2003
  • No statement about the failure to produce evidence-based patient information leaflets, as recommended by NICE 2003
  • Failure to address the need for proper regulation of ECT, rather than optional, in house monitoring by the Royal College of Psychiatrists 

The letter concludes:

Failure to address these concerns would represent a wilful neglect of patient safety, and a breach of NICE’s own commitment to evidence-based practice. …We trust the committee will, even at this late stage, and in line with its own principles and procedures, reconsider’. 

One of the signatories is Dr Sue Cunliffe who is no longer able to work because of the brain damage caused by ECT. She commented, in a media release about the letter:

‘NICE’s failure to produce strong, evidence-based guidelines in the past contributed to my ending up brain-damaged. Their new draft guidelines are a breach of their own principles and would be a massive step backwards, giving psychiatrists the green light to practise even more unsafely than was the case when they damaged my brain’

One of this blogs’ authors, Dr Chris Harrop, wrote:

‘Passing responsibility for setting standards to the Royal College of Psychiatrists’ ECT Accreditation Service, as suggested in the draft, would be like asking a drug company to set safety standards for its own drugs. The conflict of interest is blatantly clear.’ 

‘Despite our making sure that the committee was aware of recent research into how badly ECT is currently being administered, they have produced a negligent draft which abandons the principles of evidence-based medicine. Dropping the call they have been making for 20 years for robust research into efficacy and safety would be a chilling development.’

Consultant Clinical Psychologist, Dr Lucy Johnstone, added;

‘Something has gone seriously wrong at NICE to produce such a blatantly inadequate document that would inevitably put patients’ safety at risk. Professionals and patients have been campaigning about this for years. We hope they have sufficient  integrity to reconsider’.

Sophie Corlett, Director of External Relations at Mind said:

‘While there has been some good progress in NICE’s draft guidance on depression in relation to access to different therapies, we urgently need to see that progress built on further by NICE re-appraising the effectiveness and safeguards around the use of ECT. We know that some people have found it effective for improving symptoms of mental health problems – particularly depression – when nothing else has worked while others have experienced serious adverse side effects. This re-appraisal must involve people with lived experience of depression and ECT and must be timely so as not to further delay the introduction of the new treatment guidance. We also need to see NICE make recommendations relating to better data collation and reporting for those who have experienced adverse side effects as a result of ECT.’

English solicitors Freeths LLP are currently preparing claims on behalf of patients who have suffered long-term memory loss as a result of ECT administered without their informed consent:

Meanwhile, in the USA, a manufacturer of ECT machines in the USA has filed for bankruptcy because so many lawsuits have been filed against it that it can no longer get insurance:

4 Responses to Blog: New NICE Guidelines for ECT are dangerously inadequate, say 50 patients and professionals

  1. Michael Z Freeman 17/01/2022 at 9:59 am #

    Great to see progress ! However I’d caution victims to be careful of legal challenges. I was damaged back in 2006 and it took me until last year to try and start legal action. However I was told that “it’s too long ago”. Absurd when ECT obviously causes long term damage. I was told there may be a class action in the future where the time limit is waived. This is also like the asbestos issue where victims eventually forced the gov to waive the time limit. However, as I found out, this can take an enormous toll emotionally for someone like me after struggling through 15 years of hell only to have solicitors telling me “it’s too long ago”. I was assaulted and violated. This is battery. These legal claims should not be in the medical negligence realm but should be criminal prosecutions for assault and battery. I was left feeling like the solicitor was just looking for another area to make easy money out of and was not willing to fight more complicated cases.

  2. Orli 17/01/2022 at 10:17 am #

    Undoubtedly ETC treatment should dissappear!
    Sadly less than one year ago I cross through an article on the web promoting the financial gane for psychiatrist of promoting such barbaric “treatment”.

    I would like to take this opportunity to make a reflection.

    In the actual climate where the bio weapon aka covid vaccine has been identified as a possible “mass murder” technic, by irrefutable scientists studies, should we liberated all the patients labeled as Schizofrenia or delusional on suffering from prosecution ideas and therefore miss diagnose and wrongly treated, from the hands of psychiatrist?
    Or should we go all in? 🙂

    Please share your thoughts!

  3. Sarah Price Hancock 18/01/2022 at 1:24 am #

    Given the research developments identifying long-term consequences including significantly increased suicide mortality (5.7x), major adverse cardiac events & recent admission by ECT device manufacturer that treatment risks include permanent brain damage, as someone who lives with ECT’s ionizing brain and spinal cord injury let me just say ECT is the gift that keeps giving. If NICE doesn’t carefully consider all related risk research and warnings its because they’re making guidelines without studying treatment pathology and without a bioengineer on the council. In other words, they’re proposing guidelines outside the council’s scope of practice.

  4. Rosemary Knowles 18/01/2022 at 11:43 am #

    Gosh – this takes me back to all the campaigning against antidepressant drugs I did between 2016 and 2019 – and all the books i studied at the time – only to conclude that psychiatry was totally manipulative, and psychiatric drugs extremely harmful to deadly in their effects. I knew little about ECT personally – but all those studies came in handy when Covid 19 arrived – I vowed that I would in no way submit to a vaccine that was experimental and not tested thoroughy, and made by the same pharmaceutical demons and corrupt, money-making exploitative criminals I fought against before. No regrets – just that so many people have been fooled and brain-washed by the powers-that-be and are following this evil road. However, the UK Police are investigating the vaccine -roll-out as a crime against humanity – so please access this – Metropolitan Police investigation, CRIME No. 6029679/21 – good luck with that.

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