Lourdes Velasco |
Madrid (EFE) It is an “effective” technique in very serious cases, psychiatrists say, although its use is sometimes controversial.
There are no data on how many people are treated each year with this technique, but “electroconvulsive therapy” -as the treatment is formally called- is not residual, explained several psychiatrists consulted by EFE following the discovery of the case of a young man treated for will of his family by judicial order in the Provincial Hospital of Conxo, in Galicia.
The therapy was authorized by the Court of First Instance number 6 of Santiago based on the conclusions of a judicial and forensic examination of the patient and the complementary report issued by a psychiatrist, and there is a social mobilization against this sentence.
Scientific Evidence and Indicated Uses
As a result of this case, the Spanish Society of Psychiatry and Mental Health has issued a statement in which it defends that the efficacy is “unquestionable” from the scientific evidence. The technique is “clearly stigmatized” by an imaginary linked to the punishment or control of patients that “does not have any resemblance to the application” today.
The medical society explains that the main indications for use are catatonia, depression, schizophrenia and other psychotic disorders as well as mania.
“Their results are unappealable. Its effectiveness is much higher than placebo, psychotherapy or antidepressants. It manages to resolve 80% of the most serious cases and 50-60% effectiveness in three weeks, in which psychotherapy and drugs have already proven ineffective,” the statement says, although doctors such as José Valdecasas, psychiatrist and deputy secretary of the Spanish Association of Neuropsychiatry, are not so convinced that this is the case.
The president of the Spanish Society of Psychiatry and Mental Health is Manuel Martín, who explains to EFE that in Spain the therapy is applied to people with severe symptoms that are resistant to other treatments, not in cases of first indication. “If there is something unquestionable, it is that this technique is effective,” he defends.
A distorted image of technique
This doctor regrets that a negative image of this technique has been created. “It comes from a time when it was applied in a very different way than it is now, which is in an operating room and with very important safety requirements and with stimulation that does not cause any type of injury”, he says.
This vision is shared by Professor of Psychiatry at the University of Barcelona Miquel Bernardo, who explains: “It is a treatment that saves lives. It is valid in all the countries of the world, with limited exceptions, and it is applied in all the Spanish first-line hospitals”.
In Spain it is of second application, that is to say, it is only administered if previously other treatments have not worked.
Dr. Miquel Bernardo points out that the treatment reduces the burden and the effects of drug use. “Another thing is that there is a bad press or misuse outside of medical use. It is a treatment like any other, which is neither harmful nor painful nor punitive ”, he maintains.
Memory losses, the main side effect
Dr. José Valdecasas is less emphatic. “It is a highly controversial issue on which there is no monolithic opinion, neither in the association nor much less in Spanish psychiatry,” this psychiatrist and deputy secretary of the Spanish Association of Neuropsychiatry explains to EFE, clarifying that for this reason he speaks on his behalf. and not in that of the entire medical society.
He also reinforces the idea that its current use has nothing to do with that of the movies but he assures that “the belief that it is very effective has fallen a bit” and he maintains that the facts do not prove it. He further points out that the beneficial effects are short-lived.
“The efficacy is very poor and the side effects are not catastrophic, but they are there very frequently. It affects memory. Many patients later have difficulty remembering certain events, and well, it’s a lot of general anesthesia and there is always a small risk of mortality that is very small but it is present, ”she says.
The document of the medical society itself states that there are two main types of memory disorders. The first of these is “quickly forgetting new information”, for example difficulties remembering conversations or things they have recently read.
“The second type of memory loss concerns events of the past. Some patients will have gaps in their memory of events that occurred in the weeks or months and, less frequently, years before the course of treatment.
There are also permanent gaps for some events, especially those that occurred close to treatment.
Can someone be forced to receive the treatment?
The most striking thing about the case of Galicia, the three psychiatrists agree, is that the treatment is administered after the intervention of a judge, but in psychiatry cases of hospitalized patients without their consent are common, Valdecasas points out.
“There may be a situation in which the person is not in a position to express their will, either because they are unconscious or because the degree of mental affectation is so serious that they cannot have decision-making capacity at that moment,” he explains for his part of the president of the company.
If the person has not indicated in their wills that they do not want certain procedures applied and the doctors consider that they could benefit from that treatment but the family opposes it, many times a judge is resorted to to rule if it can be applied or not.
Manuel Martín is emphatic on this point: “Of course, if the person needs it, what is not acceptable is that the treatment is not applied. Really, the people to whom the use is proposed are always in very serious situations.”
José Valdecasas, for his part, understands the perspective of patient associations but also believes that there is a “very tenuous balance” between treatments and paternalism, but understands that sometimes doctors have to request authorization from the judge because there are alterations behaviors that endanger the safety of the patients themselves.