A 16-year-old girl with severe depression associated with an eating disorder is to receive up to 12 sessions of electroconvulsive therapy (ECT) in what a court heard will be life-saving treatment for her.
High Court president Mr Justice Peter Kelly yesterday ordered the therapy for the girl who, he was told, is a high achiever whose depressive illness has become so severe that she says she wants to die.
She harms herself including by running at walls to bang her head, the court heard. Granting the treatment orders sought by the HSE, the judge was satisfied it was a rare case in which ECT was “not only warranted but demanded”.
All other medication, support, and psychotherapy had not succeeded in improving her condition, he said.
The court heard that her depression is so deep she is now “almost mute”.
The judge said it was clear this can be said to be life-saving treatment because from the evidence she is endeavouring to bring an end to her life, such is her deluded view of herself as being worthless.
He was satisfied the advantages of ECT far outweigh its disadvantages. He noted its success rates in dealing with severe depression were between 50% and 70%, and that side effects appeared to be limited to some memory loss for the patient.
It is carried out under anaesthetic but the risks of a reaction to this from the girl were no greater than in most cases, the court heard.
The judge also took into account that the College of Psychiatry in Ireland, and its equivalent in the UK, while aware of some public concern about ECT, had said it was highly effective.
A psychiatrist treating the girl told the court she first presented with anorexia nervosa with a body weight of 47kg, and a body mass index of 15. She was eating around 800 calories a day, far below the normal requirement and was also exercising, she said, to reduce her weight.
She underwent treatment at a specialist facility here and at a paediatric hospital eventually having to be fed with a tube through her nose. By this stage she was had developed significant suicidal thoughts and just over a year ago, her parents and the HSE decided to transfer her to a specialist facility in the UK dealing in eating disorders.
She agreed to the transfer and voluntary detention under UK mental health law. The psychiatrist said while her weight stabilised in the UK under nasogastric feeding, her depressive state worsened to the point where she said she did not want to live and displayed distress, self-loathing and guilt.
The doctor’s view, and that of her treating psychiatrist in the UK, was that ECT was the only option. It would be carried out in a specialist ECT facility in the UK by a psychiatrist with 25 years experience, the doctor said.
The doctor asked the court to review the treatment after eight to 10 sessions.
Mr Justice Kelly said the case could come back before him on June 10.
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