April 22, 2026

expert reaction to online survey of friends and relatives of recipients of electroconvulsive therapy (ECT)

Survey results published in Psychology and Psychotherapy: Theory, Research and Practice looks at friends and relatives of recipients of electroconvulsive therapy (ECT).

Prof George Kirov, Clinical Professor, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, said:

“This is at least the 6th paper published by this research group on this survey, with a projected total of at least 11.

“The problem with this, and the other papers, is the same: this survey is not representative of the population of people receiving ECT, making any conclusions irrelevant. The survey was widely advertised on X and on other internet sites. People from all over the world were invited to take part (from all continents except Antarctica, as described by the authors in a previous publication). Several countries were represented by a single participant. No time limit was specified either. Thus, the survey was open to many millions of people who have received ECT in past. There is no way to know if they are typical for those who receive ECT, and in fact, every reason to expect that they were predominantly people who are opposing ECT or feel damaged by this treatment. All we can learn from this survey is that there are people who feel damaged by ECT, but there is no way of knowing what proportion of ECT patients feel this way. This is not science. The claims from this survey are likely a severe  over-estimate.

“The claims in this survey are not backed up by other data. The survey claims that a substantial proportion of people felt that ECT caused brain damage, while there is no scientific evidence that this happens. ECT does cause memory problems and these are well recognised and acknowledged in the relevant Information Sheets.

“ECT is most effective in those most severely ill with depression, psychosis and mania. Remission rates of 45% are consistently reported in the population of depressed patients in the UK (annual ECTAS reports available from the Royal College of Psychiatrists website) or even higher in some well conducted trials. About two thirds of patients are reported as “much improved”.

“ECT practitioners know many relatives who thank them for bringing back their loved ones who were lost to them due to psychosis, catatonia or severe suicidal thoughts. It is one of the few treatments often described as “life-saving” by patients and their relatives. My patients cannot understand why somebody would want to stop its use, and many are frightened of what would happen to them if they get ill again and have no access to ECT.”

Dr Rich Braithwaite, Honorary Assistant Professor, Brighton & Sussex Medical School, said:

Does the press release accurately reflect the science?

“Notwithstanding flaws in the survey itself, the press release gives quotes from the authors and their own relatives. These are not the purported ‘research’ participants, but the researchers themselves. Their experiences are not relevant to the survey’s findings and there is little place for them in the press release.

Is this good quality research?  Are the conclusions backed up by solid data?

“This is poor quality research. The main problem is the sampling undertaken. This is not clearly reported. Recruitment via mental health organisations was mentioned; this in itself would be likely to have introduced significant bias. However, even more concerning is the statement “The survey was also disseminated via social media.” No further information is given and there is no information on the proportion of subjects recruited via the various means. The final author, a veteran campaigner against ECT, has 12,700 followers on X and 1,900 on Facebook. These are likely to have been the main source of participants. Many of these followers are disgruntled with mental health services as a result of their personal experiences, some with good reason – we recognise that services are not always well delivered worldwide and also that ECT can cause side effects and does not work for every patient. The point is that this sample is far, far from representative of family and friends of patients receiving ECT internationally, tipped strongly towards those ready to express negative opinions on the treatment. Such sampling methods are only ever appropriate for qualitative research, and render the quantitative findings of this survey meaningless.

How does this work fit with the existing evidence?

“Naturally, the findings of this paper fit well with that from similarly poorly conducted research from the final author and his collaborators. Conversely, it differs markedly from the findings of both randomised trials and large-scale observational studies alike, which suggest the majority of patients who receive ECT benefit from it, that clinical deteriorations are only seen in a very small minority, and that the memory impairment caused by ECT is transient for most patients.

Have the authors accounted for confounders?  Are there important limitations to be aware of?

“The nature of this research (even if it had been well conducted using appropriate sampling, for instance) does not require accounting for confounders: all the subjects had a relative who had had ECT, so it is not trying to establish a statistical association between ECT use and specific outcomes. Rather, the fundamental limitation is in its sampling methods, as outlined above. This is mentioned by the authors but their suggestion that this was minimised by adding specific wording to their social media posts is highly unrealistic. It should also be noted that, because recruitment was open to any English speaker worldwide who claimed to have a friend or relative who had had ECT at any time in the past, the response rate for this survey is tiny and much, much lower than would typically be accepted by a medical journal. About 1.4 million people have ECT worldwide each year (conservatively, 20 million over the past 20 years). 20% of the world’s population has proficiency in English. As a very rough estimate, there are perhaps some 4,000,000 patients who have at least one friend or relative who could have responded to this survey. Only 286 responded, yielding a response rate of 0.007%.

What are the implications in the real world?  Is there any overspeculation?  

“The main implication of this paper is that vulnerable patients and their relatives could be put off considering a medical treatment that might be effective for their illness, after reading about this paper and its deeply flawed, over-speculative, quantitative findings. This would be a tragedy.”

Prof Robert Howard, Professor of Old Age Psychiatry, UCL, said:

“Because of the self-selected and therefore unrepresentative nature of the survey sample I don’t consider this to be a methodologically good quality study. ECT is an effective and life-saving treatment, used only when depression is severe and life-threatening and other treatments have failed or it would be dangerous to delay and wait for them to have an effect. It is also stigmatised and feared by the public and patients within the mental health system. We know that ECT is effective and safe (certainly very much safer than untreated severe depression) from well-conducted and truly independent studies. It is recommended by NICE, who examined the research evidence independently and carefully.

“Well-conducted studies have shown that memory loss, particularly affecting autobiographical memory, is seen in some people who have received ECT. However, there is no evidence of general impairment of cognitive functioning, and some studies have actually shown a reduced incidence of dementia in people who have been treated with ECT. As a doctor who has recommended this treatment to my patients, some of whom I know would have died or been reduced to a life of institutionalisation and suffering without it, I think it is important to understand just how important and positively life-changing ECT can be.

“When interpreting this latest study from this group of authors it is important to understand that they have critical views against ECT and even the wider concept of conventionally agreed mental health diagnoses and the use of established and NICE-approved treatments, including antidepressants and antipsychotics. This is reflected in many of their earlier publications. It’s very important that readers bear this in mind when they look at the paper, together with the fact that this was a self-selected survey population that is not generally representative of people with experience of ECT having been given to a family member. Ironically, the strongest advocates that I come across for ECT are my own patients who have received the treatment and their families and friends, who recognise the power of the treatment to pull people out of the terrible suffering and danger that they have been in.”

‘An international survey of the relatives and friends of electroconvulsive therapy recipients’ by first author et al. was published in Psychology and Psychotherapy: Theory, Research and Practice at 8:01 UK time on Wednesday 22^nd April. 

DOI: 10.1111/papt.20062

Declared interests

Prof George Kirov: I have interests to declare: royalties for authoring two books on ECT.

Dr Rich Braithwaite: “I have no completing interests.”

Prof Robert Howard: “No relevant conflicts of interest.”