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Dear Colleagues: Some of you may have read the Toronto Star story on electroconvulsive therapy (ECT), used in the treatment of severe depression, that was published on Friday, December 14, 2012. The story stated that the treatment is being used in ever greater numbers, that there are no guidelines, and compared it to an "assault" on the brain.
While UHN is not mentioned in the article, I would like to clarify these inaccuracies, as UHN does offer this therapy. The article does not take into account the latest research on the remarkable progress in brain stimulation treatments and ECT for depression, some of which were pioneered at UHN. Brain imaging studies have shown that ECT as it is performed today does not harm the brain, and is actually associated with the process of stimulating new cell growth in the brain. ECT is also known to adjust the levels of brain chemicals which are involved in mood regulation, such as serotonin and noradrenaline. Many patients with serious mood disorders, who have not been able to respond to various medications or other therapies, have been helped by ECT.
Moreover, over the last 10 years, ECT practice has evolved considerably, in how it is administered, the type of equipment used, and the recognition of the specific disorders which are alleviated by the treatment.
Use of ECT at UHN has remained steady over the past 10 years, and patients who receive it are severely depressed, have depression with psychotic features, are suicidal, or are so depressed that they do not eat or drink. To treat these patients, UHN has state-of-the art machines, excellent anesthesia support and a compassionate team of professionals to care for the patients before and after their therapy. No serious adverse events have been reported at UHN as a result of this treatment and the aim is always maximal therapeutic effect with minimal side effects.
UHN adheres to Canadian guidelines for the use of ECT, published in 2009 by the Canadian Network for Mood and Anxiety Treatments (CANMAT). Two of our physicians, Drs. Sid Kennedy and Peter Giacobbe, contributed to developing these guidelines, which establish best standards of practice. Sid and Peter helped write this Straight Talk. Clearly we support the standards for equipment and the residents who train with us are taught the proper use of the equipment within the guidelines for use of this treatment.
The decision to use ECT is a careful and thoughtful process, which weights risks and benefits, considers a patient's illness and history, and, of course, relies upon well-informed consent. For those patients with severe and difficult to treat forms of illness, ECT remains an important and potentially life-saving treatment option.