Professor Ian Hickie’s shocking each way bet on ECT induced amnesia

When researchers expressed concern about ECT induced long term memory loss he scathingly dismissed them, despite having eleven months earlier proposed that pharmacological interventions may be warranted to alleviate that same side-effect.

Professor Ian Hickie is the co-author of the article, ‘Electroconvulsive therapy-induced persistent retrograde amnesia: could it be minimised by ketamine or other pharmacological approaches?’, published in January 2010 in the Journal of Affective Disorders.  The article stated, ‘available evidence indicates that ECT is objectively associated with persistent RA [retrograde amnesia], and both clinicians and patients report that RA is distressing for patients’.[1. Gregory-Roberts, E. M., Naismith, S. L., Cullen, K. M., & Hickie, I. B. (2010). Electroconvulsive therapy-induced persistent retrograde amnesia: could it be minimised by ketamine or other pharmacological approaches? Journal of Affective Disorders, 126(1-2), 39-45. http://www.jad-journal.com/article/S0165-0327(09)00525-4/abstract ] It outlined several hypotheses for the relationship, but stated that ‘The mechanism for ECT-induced RA is unclear.’[2. Gregory-Roberts, E. M., Naismith, S. L., Cullen, K. M., & Hickie, I. B. (2010). Electroconvulsive therapy-induced persistent retrograde amnesia: could it be minimised by ketamine or other pharmacological approaches? Journal of Affective Disorders, 126(1-2). (p. 40) http://www.jad-journal.com/article/S0165-0327(09)00525-4/abstract ]

The article concluded that the problem of ECT-induced retrograde amnesia (long-term memory loss) was ‘common, significant and undesirable’,[3. Gregory-Roberts, E. M., Naismith, S. L., Cullen, K. M., & Hickie, I. B. (2010). Electroconvulsive therapy-induced persistent retrograde amnesia: could it be minimised by ketamine or other pharmacological approaches? Journal of Affective Disorders, 126(1-2). (p. 43) http://www.jad-journal.com/article/S0165-0327(09)00525-4/abstract] and that it warranted experimentation with the simultaneous administration of ketamine or other pharmacological approaches to see if this prevented the memory loss.  It suggested the possibility that other ‘physical treatments for depression, such as transcranial magnetic stimulation, magnetic seizure therapy, vagus nerve stimulation, and transcranial direct current stimulation [might] achieve an antidepressant effect without the cognitive side effects of generalised physical therapies such as ECT.  However, it is possible that there is a simpler solution to the problem, and trialing ketamine for reducing ECT-induced RA would seem a cogent next step forward.’[4. Gregory-Roberts, E. M., Naismith, S. L., Cullen, K. M., & Hickie, I. B. (2010). Electroconvulsive therapy-induced persistent retrograde amnesia: could it be minimised by ketamine or other pharmacological approaches? Journal of Affective Disorders, 126(1-2). (pp. 43-44) http://www.jad-journal.com/article/S0165-0327(09)00525-4/abstract]

Eleven months later, however, Professor Hickie emphatically told The Age that the findings of a newly published review article[5. Read, J., & Bentall, R. (2010). The effectiveness of electroconvulsive therapy: a literature review. Epidemiologia e Psichiatria Sociale, 19(3), 333-347. http://psychrights.org/Research/Digest/Electroshock/2010ReadBentallElectroshockReview.pdf ] critical of the long-term effects of ECT ‘were ”ridiculous” and that while previously it was presumed that ECT caused memory loss, advances in brain imaging had shown the patient’s depression was often to blame.’[6. Jill Stark, Call for ban on shock therapy The Age, December 19, 2010 http://www.theage.com.au/victoria/call-for-ban-on-shock-therapy-20101218-191e2.html] That review article was written by Professor Richard Bentall from Bangor University (Wales) and Professor John Read, from Auckland University.

There were no Eureka-moment breakthroughs in brain imaging of people with depression between November 2009 (when the article was resubmitted and accepted) and December 2010 that could account for Professor Hickie’s massive about-turn.  In addition, Professor Hickie’s co-authored article never suggested that ECT-induced permanent memory loss was caused by patients’ depression.

Professor Hickie clearly disagrees with the findings of Bentall and Read’s review article and supports the continued use of ECT.  Professor Hickie is not alone, in that many psychiatrists support the use of ECT, and it is not unusual for experts to disagree with findings of a review article.  But dismissing them as ‘ridiculous’ while contradicting the fundamental basis of his own recent paper is astonishing behaviour.

I stated in my recent blog highlighting the Hickie-Lancet controversy that my experience of Professor Hickie has ‘left me wondering about the depth of his understanding of research he was prepared to critique’. (see http://speedupsitstill.com/professor-ian-hickie-visionary-mental-health-reformer-paid-pharmaceutical-industry-opinion-leader )  I am now wondering if he even fully understands what he signs as a co-author.

I also wrote that ‘I have observed Hickie’s comments on a range of issues.  In my experience he speaks on anything and everything related to mental health and usually takes a position that maximises the potential benefits and minimises the potential risks of medical (read pharmaceutical) over behavioural interventions’.  Professor Hickie appears to have done exactly this with ECT when interviewed by The Age. When other researchers expressed concern about an undesirable side-effect, he scathingly dismissed them, despite having proposed that pharmacological interventions may be warranted to alleviate that same side-effect.

Professor Ian Hickie is one of eight Mental Health Commissioners tasked with providing ‘expert and independent advice to the [Australian] Government on the performance of our mental health system’.[7. The Hon. Mark Butler MP, Leading Australians to Spearhead National Mental Health Reform (media release), 11 December 2011. http://www.health.gov.au/internet/ministers/publishing.nsf/Content/7B43BA089E706CD8CA2579640010F23B/$File/MB223.pdf]  As a result of numerous issues with Professor Hickie’s Lancet article promoting Servier’s Valdoxan, on 12 February 2012, I told The Australian Professor Hickie should ‘step aside as a mental health commissioner’, adding ‘if he doesn’t (Mental Health Minister) Mark Butler should remove him’.[8. Sue Dunlevy, Campaign Targets Deprerssion Guru, The Australian, Monday 13 February 2012   http://www.theaustralian.com.au/news/health-science/campaign-targets-depression-guru/story-e6frg8y6-1226269135293]

I was unaware of Professor Hickie’s contradictory positions in relation to ECT when I made the call for his removal as a National Mental Health Commisioner. The more I know about Professor Ian Hickie, the more concerned I become about his suitability for this important role.