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The Rate of Usage of Electroconvulsive Therapy in the City of Edinburgh, 1993-2005

Background: In May 2003, the National Institute for Clinical Excellence published controversial clinical guidelines that intended to restrict the indications for the use of electroconvulsive therapy (ECT) in the United Kingdom. Objective: We investigated whether the guideline had affected the rate of usage of ECT in the City of Edinburgh and set this in the context of ECT usage in the City since 1993. Method: We calculated the annual rate of ECT usage using a case register and contemporaneous and coterminous population data, reporting separately rates for young people (younger than 18 years), the general adult population, and older adults (aged 65 years of age and older). Results: No young person was treated after 1998. There were similar significant falls in the rates of usage in both the general adult and older age population (−60%). There was no suggestion that the fall had accelerated after May 2003. Conclusions: No early effect of the guidance was found in the rate of ECT usage in the City of Edinburgh, but the passage of time will be required to assess any longer term effect.