Stakeholders’ Ethical Concerns Regarding Psychiatric Electroceutical Interventions: Results from a US Nationwide Survey

Abstract

Background

Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders’ perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), and adaptive brain implants (ABI).

Methods

We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs.

Results

Participants’ ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies.

Conclusions

To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs.

Keywords:

• Ethical concerns
• brain stimulation
• neuromodulation
• depression

Acknowledgements

We thank Patricia Henegan for her help with proof reading.

Conflict of interests

LC, ES, RB, AM have no conflicts of interest to declare. Dr. Achtyes has served on advisory boards for Alkermes, Janssen, Lundbeck/Otsuka, Roche, Sunovion, Teva and CAPNOSZero (unpaid), reports previous stock holdings in AstraZeneca, Johnson & Johnson, Moderna, and Pfizer. Dr. Achtyes has received research support from Alkermes, Astellas, Biogen, Boehringer-Ingelheim, InnateVR, Janssen, National Network of Depression Centers, Neurocrine Biosciences, Novartis, Otsuka, Pear Therapeutics, Takeda and serves on the SMI Adviser LAI Center of Excellence (unpaid). This study was supported by a BRAIN Initiative grant (#RF1MH117802) from the US National Institute of Mental Health.

Ethics approval information

This study was approved as exempt by the Michigan State University IRB (STUDY00001247).

Additional information

Funding

This study was supported by a BRAIN Initiative grant (#RF1MH117802) from the US National Institute of Mental Health to (PI: LC). The funding source had no influence on the study design; the collection, analysis, and interpretation of data; the writing of this manuscript; or the decision to submit the manuscript for publication.