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The use of electroconvulsive therapy
Understanding NICE guidance ­
information for service users, their advocates
and carers, and the public
Issue date: April 2003
To order copies
Copies of this booklet can be ordered from the NHS Response Line;
telephone 0870 1555 455 and quote reference number N0207. A
version in Welsh and English is also available, reference number
N0208. Mae fersiwn yn Gymraeg ac yn Saesneg ar gael hefyd, rhif
cyfeirnod N0208.…read more

Page 3

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What is NICE guidance? 4
What are depressive illness, mania,
schizophrenia and catatonia? 5
What is electroconvulsive therapy? 7
What has NICE recommended? 8
What should I do? 11
Will NICE review its guidance? 11
Further information 12…read more

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What is NICE guidance?
The National Institute for Clinical Excellence
(NICE) is part of the NHS. It produces guidance
for both the NHS and patients on the use of
medicines, medical equipment, diagnostic tests
and clinical and surgical procedures and under
what circumstances they should be used.
To produce this guidance, NICE looks at how
well the medicine, equipment or procedure
works and also how well it works in relation to
how much it costs. This process is called an
appraisal.…read more

Page 5

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What are depressive illness, mania,
schizophrenia and catatonia?
Depressive illness, mania and schizophrenia are all
mental health disorders.
Depressive illness is associated with a change in
mood that may not have an obvious cause. It
involves feelings of sadness, despair, hopelessness
and helplessness, lack of interest in life and
difficulty concentrating. These feelings deepen
over time. People with severe depressive illness
may be unable to eat or sleep or to take part in
social activities, and may become completely
withdrawn.…read more

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Schizophrenia is a major mental illness that
involves a range of symptoms that affect
understanding, emotion and behaviour. When
people are ill with schizophrenia they usually
hear voices (hallucinations) and develop strange
ideas and beliefs that others don't agree with
(delusions), although exactly what type of
symptoms a person has is very individual.…read more

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What is electroconvulsive therapy?
Electroconvulsive therapy (or ECT for short) is a
treatment that has been used in the treatment of
depressive illness, mania, catatonia and,
occasionally, schizophrenia. Although ECT has
been used since the 1930s, how it works is still
not fully understood.
During ECT, electrodes are put onto the head and
an electric current is passed briefly though the
electrodes to the brain, which causes a seizure (a
`fit').…read more

Page 8

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People can make `advance directives' about their
treatment. An advance directive is a written
statement made by someone who is mentally
capable of deciding about the treatment they
want or do not want to receive if the need arises
in the future and they are mentally incapable of
giving consent. Advance directives guide health
professionals in the event that someone becomes
unable to make decisions for him or herself.…read more

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Doctors should be particularly cautious when
considering ECT treatment for women who are
pregnant and for older or younger people,
because they may be at higher risk of
complications with ECT.
Someone who is mentally capable of making a
decision about their treatment should decide,
after discussion with the doctor, whether or not
they want to give their consent to have ECT.…read more

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If discussion and informed consent are not
possible at the time treatment is needed, any
advance directive should be fully taken into
account and someone who speaks on behalf of
the person who is ill, or their carer(s), should be
The person should be re-assessed after every
session of ECT. There should be ongoing checks
for any signs of memory loss, and as a minimum,
a check at the end of each course of treatment.…read more


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