To compare electroconvulsive therapy (ECT) practice between London in the United Kingdom and Bengaluru in India.
A retrospective case note study was conducted to compare patterns of referrals for ECT in university teaching hospitals in London (n = 46) and Bengaluru (n = 345) during a 1-year period. Further comparison of ECT practice was made for a consecutive series of depressed patients between London (n = 104) and Bengaluru (n = 125).
The rates of ECT referral were 0.9% of total annual admissions at the London site and 8.2% at the Bengaluru site. At the Bengaluru site, a higher proportion of patients were referred for ECT with a diagnosis of schizophrenia (P < 0.0001). Compared to the Bengaluru sample, depressed patients treated with ECT in London (n = 104) were older with more treatment resistance (P < 0.0001), had longer inpatient stays, and were less responsive to ECT.
The practice of ECT differed substantially between the London and Bengaluru sites. The relatively limited use of ECT in London reflects local treatment guidelines and may reflect the stigma associated with ECT. Electroconvulsive therapy is more widely used in Bengaluru with good outcomes. Further cross-cultural research is required to study the reasons for such contrasting practices and what constitutes the optimal practice of ECT for health systems in different countries.
From the *Newham Early Intervention Service, and †Institute of Psychiatry,King’s College London, London, UK; ‡National Institute of Mental Health and Neurosciences, Bengaluru, India; §NHS Greater Glasgow and Clyde; ∥Department of Neuroscience, University of Sheffield, Glasgow; ¶Department of Health Sciences, University of Leicester, UK; and #Department of Psychiatry & Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick’s University Hospital, Dublin, Ireland.
Received for publication September 20, 2010; accepted January 4, 2011.
Reprints: Savithasri V. Eranti, MRCPsych, MD, PhD, Newham Early Intervention Service, Unit 9 Stratford Office Village, 4 Romford Rd, London E15 4EA, UK (e-mail: Savitha.Eranti@kcl.ac.uk; Savitha.Eranti@eastlondon.nhs.uk).
This work was carried out with funding support from the National Health Service Health Technology Assessment program. Statistical analysis was carried out by the first author at the Institute of Psychiatry, London.
Dr Gangadhar has made an application for a patent along with Mr Candade, a manufacturer of an ECT machine, on a component feature of the ECT machine.
The authors declare no conflict of interest.