Leading international psychiatry organizations have issued a joint statement criticizing how electroconvulsive therapy (ECT) is portrayed in recent World Health Organization (WHO) guidance, warning that misleading claims could stigmatize a treatment they describe as safe, effective, and sometimes lifesaving.

In the statement, the World Psychiatric Association, American Psychiatric Association, European Psychiatric Association, and the global expert task force on ECT said they support the WHO’s broader push for “rights-based, person-centered, and recovery-oriented” mental health policies.

However, they raised serious concerns that the guidance contains “scientifically inaccurate and misleading statements” regarding ECT.

These statements portray ECT as “inherently dangerous and advocate for its restriction or prohibition, thereby reinforcing stigma and potentially limiting access to evidence-based care for severely ill patients,” David Zilles-Wegner, MD, Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany, and others wrote in the statement.

The statement was published online on March 31 in The Lancet Psychiatry.

Out of Touch With Modern ECT

ECT is supported by decades of research and clinical guidelines worldwide, the authors wrote, which demonstrates that ECT is an effective, safe, and well-tolerated treatment, particularly in cases of severe depressive episodes, bipolar disorder, schizophrenia, and catatonic states in which patients are barely able to speak or move.

They also pushed back against calls to restrict ECT in certain populations, including minors and patients unable to provide consent. “Denying ECT in life-threatening situations, including in children and adolescents or in patients who lack decision-making capacity, would be unethical,” the authors wrote.

Mark George, MD, who was not an author on the statement, agreed. The WHO guidance “misrepresents modern ECT and how it should be used in practice,” said George, a distinguished professor of psychiatry, radiology, and neuroscience and director of the Brain Stimulation Division, Medical University of South Carolina in Charleston, South Carolina.

“The WHO document has thrown the baby out with the bathwater. That is, in their attempt to make sure patients are informed and give consent for care, they have misstated facts about ECT,” George told Medscape Medical News.

“If a patient is manic or catatonic there are quite appropriate ways to obtain consent, that all US practitioners use. ECT is still our most effective acute treatment for treatment-resistant depression and catatonia. It is a lifesaver with high rates of efficacy,” George said.

He noted that even with many other brain stimulation treatments now available — such as transcranial magnetic stimulation, vagus and other cranial nerve stimulation, and transcranial direct current stimulation — ECT is sometimes “the only treatment that will work for some patients. The WHO guidance is incomplete and unfortunately out of date in terms of its references about modern ECT,” George said.

The statement authors have called on the WHO to integrate robust scientific evidence and lived experience into future guidance on ECT.

In a statement to Medscape Medical News, the WHO noted that the organization reviews available evidence periodically.

“Combining scientific evidence with human rights aspects is essential in any medical practice and especially so in psychiatry, given its history,” the statement said. “WHO is looking forward to update available evidence and consult with people with lived experience and psychiatric associations alike.”

Disclosures for statement authors are available in the original publication. George is editor-in-chief of Brain Stimulation: Basic, Translational and Clinical Research in Neuromodulation.