Personal Experience with ECT from a Psychiatrist- a Stigma-Reducing Endorsement

Out on PubMed, from a retired clinician, is this commentary:

My Benefits From Electroconvulsive Therapy-What a Psychiatrist Learned by Being a Patient.

Barchas RE.Psychiatr Serv. 2020 Nov 10:appips72301. doi: 10.1176/appi.ps.72301. Online ahead of print.PMID: 33167818 

The pdf is here.

The text begins:

I always thought of myself as a good psychiatrist, actually a very good psychiatrist. I saw much improvement in almost all of my patients and could control each person’s symptoms with psychopharmacological medications and with psychotherapy, which I loved to do. I never had to refer more than about 1% of my large patient population to hospitals, even though some of my patients were very ill. I could maintain treatment on an outpatient basis, and, in my 34 years of private practice, I never had a patient commit suicide. Now I am 71 years old and have been retired 8 years. Yet I realize now that despite having been a board-certified psychiatrist and a Life Fellow of the American Psychiatric Association, I was ignorant about something very important—the full range of patients who could receive the broad spectrum of benefits from electroconvulsive therapy (ECT). I rarely referred patients for ECT and always thought of it as a last resort. I was not sufficiently knowledgeable of the benefits of ECT until I myself was the beneficiary.

and concludes:

If reading these thoughts can help even one more patient who needs ECT accept it or help one more physician to consider recommending it when appropriate, I will have accomplished my goal of helping to destigmatize ECT. It may not help everybody who has severe depressive symptoms, but in the hands of competent physicians, it can be a remarkably fast-acting, effective, and safe treatment option for clinical depression. As I mentioned at the start, as a practicing psychiatrist, I only rarely referred patients for ECT. But on the basis of my own experience, I now can see that for some patients ECT should be considered sooner and not just as a last resort. I wish I had gained that realization before I retired. I still think I was a good psychiatrist, but I would have been an even better one if, at the time, I had more fully recognized and appreciated the full range of patients who could benefit from ECT.

This is a wonderful addition to the ECT literature. I hope it is widely read; readers of this blog please pass it on. 

The fact that practicing psychiatrists rarely think of ECT as an option for their patients is a remarkable fact. I have encountered many referring psychiatrists who consider it a failure of their competency to have to refer a patient for ECT. 

Dr. Barchas has contributed a courageous. forthright call to recognize ECT as a standard treatment in modern psychiatry, not a "last resort."

Her words are a powerful plea to destigmatize ECT.

Thanks to her for boldly sharing her experience.