Content note: this post discusses sexual violence, psychiatric treatment and medical trauma.
Women live longer than men. We all know that, right? Well, technically women in the UK live 3.9 years longer than men. However, the advantage in healthy years is only ten weeks. 10. That’s it, from the Office for National Statistics’ own tables: life expectancy 83.0 against 79.1, healthy life expectancy 60.9 against 60.7 [1]. Everything after the healthy years is illness, and women get more of it: around 22 years lived in poor health against men’s 18, which is why men spend 77% of their lives in good health and women 73% [1]. So when somebody answers any of what follows with “but women live longer,” and somebody always does, they’re right, and what we’re living longer in is the sick years. It’s most likely painful and difficult.
Women experience a very different path through the medical system that men mostly don’t. Often, a woman goes to the GP with something wrong with her body. The system can’t explain it, or doesn’t look, and treats her mind instead.
Studies running back through the 1980s and 90s found that men reporting pain tended to get painkillers while women got sedatives, and a 2014 study that asked clinicians to treat identical hypothetical back-pain patients found they recommended antidepressants more often when the patient was a woman, documented in Caroline Criado Perez’s Invisible Women [2].
Researchers at Leeds went through the records of 564,412 heart attack patients in England and Wales and found women were 50% more likely than men to be given the wrong initial diagnosis, and for the most serious kind of heart attack, 59% more likely. Patients who got the wrong first diagnosis had a 70% higher risk of being dead within a month [3]. 33,000 women are admitted to hospital with a heart attack every year in the UK, one every sixteen minutes, and coronary heart disease kills twice as many women as breast cancer [3]. Women’s heart attacks got labelled as anxiety, indigestion or panic.
Endometriosis affects one woman in ten, and the latest Endometriosis UK report puts the average wait from first GP visit to diagnosis at nine years and four months, longer than it was two years ago, longer than it was before the pandemic, and moving in the wrong direction [4]. Around 750,000 women are waiting for gynaecology care across the UK, and in England it is now the largest waiting list of any specialty for working-age people [4].
In the year to March 2026, 5.9 million women in England were prescribed antidepressants, against 3.2 million men. Women are 65% of everyone on them. Among 15 to 19 year olds prescribed antidepressants, 71% are girls [5]. Some of that reflects real depression, and depression is real, and medication genuinely helps many people.
Childhood trauma is one of the strongest known risk factors for adult depression: across studies, people who lived through it are about twice as likely to develop depression as adults [6]. NICE’s own guidance: for less severe depression, talking therapy comes first, and medication shouldn’t be the routine opening move [7].
The reality is ten minutes with a GP and a prescription, because the talking therapies system referred over 1.5 million people in a year and fewer than half completed a course of treatment [8]. And completing it doesn’t even mean much: officially it’s attending just two sessions, most people who fall out never get past the first appointment, and a typical low-intensity course is only four to six half-hour sessions anyway [8]. When it doesn’t work, she becomes “treatment-resistant”, which simply means two courses of antidepressants have failed. And treatment-resistant depression is the diagnosis that can get you referred for electroconvulsive therapy (ECT).
I was shocked to discover that ECT is still given to around 2,500 people a year in England. 67% of them are women. 58% are over 60. More than a third, 37%, receive it without their consent, under the Mental Health Act [9]. And internationally, 81% of the psychiatrists administering it are men [14]. Women have outnumbered men on the UK medical register since 2025, and psychiatry is one of the more balanced specialties, roughly half women [15]. American workforce data shows the same skew inside a single system: the more ECT a doctor gives, the more likely he is to be a man [14].
The independent audits found a 47-fold difference in usage between the NHS trusts using it most and least. And when the auditors asked England’s 56 NHS mental health trusts how many patients had been offered psychological therapy first, which NICE requires, 37 trusts responded and only one could answer [9]. The audit before it, covering 2011 to 2015, got answers from ten trusts, and their figures ran from 0% to 100% [9]. A postcode lottery.
Unbelievably there have only ever been eleven clinical trials comparing it with sham ECT, the placebo version where the patient goes through the whole procedure, without the electricity. The most recent was in 1985, over 40 years ago. The meta-analyses that support the treatment are built on between one and seven of those eleven small, old studies [10]. Since then the trials have compared ECT with other treatments instead of with a placebo. In the biggest, in 2023, ketamine did at least as well [10a]. Psychiatrists say a placebo trial now would be unethical, because it means withholding a treatment they believe works. They may be right. It also means the question can never be tested. For perspective, when researchers reviewed the evidence for antidepressants in 2018, they had 522 trials to work with [13]. Those trials are small, old and short. The biggest review of them, in the Lancet in 2003, pooled six and found a large effect at the end of the course, and no significant difference at six months. For a procedure this invasive, that is not enough. Around a million people a year worldwide receive it anyway [10]. The research on memory is contested: across studies, between 12% and 55% of recipients report persistent or permanent memory loss, with women and older people, the people who get it most, particularly affected [10, 11]. In 2018 one of the main manufacturers of ECT machines added permanent brain damage to its own list of risks [9].
The male-doctor figures come from the largest survey of ECT recipients ever conducted, published late last year: 858 people across 44 countries, 73% of them women [14]. Across the whole survey, a male doctor treating a female patient was thirteen times more common than the reverse. In the USA, where 88% of the psychiatrists were men, it was twenty-five times. Women reported worse outcomes across the board: more memory loss than the men. Less information beforehand. More pressure to consent. Only 15% said they’d have it again, against 29% of the men. It’s a survey, self-selected, run by the treatment’s best-known critic, so weigh it accordingly. But bear in mind the fact that nobody official is collecting this data at all.
The researcher who led those audits and that review, Professor John Read, is a contested figure, and psychiatrists have published rebuttals of his methods. There are also people who told researchers that ECT saved their lives. They received a course of treatment, recovered and life resumed. Both accounts are real. But both are anecdotal. The call for an independent review is backed by Mind, the Royal College of Nursing, the Association of Clinical Psychologists and the brain injury charity Headway [12]. It still hasn’t happened.
You may be aware that the word hysteria comes from the Greek for womb. Psychiatry only took the word out of its own manual in 1980.
The polite name for all of this is the gender health gap. The accurate name is patriarchy. In this case, a medical system built by men, around male bodies, running on a centuries-old assumption that women exaggerate. None of this is a case against medicine, against antidepressants, or against any woman’s treatment choices, including ECT. Women aren’t living longer than men in any way that counts. We’re ill longer.
The Receipts // (Sources)
[1] Office for National Statistics, National life tables, UK: 2022 to 2024, December 2025. Office for National Statistics, Health state life expectancies, UK: 2022 to 2024, 19 February 2026.
[2] Caroline Criado Perez, Invisible Women: Exposing Data Bias in a World Designed for Men, 2019.
[3] University of Leeds, European Heart Journal: Acute Cardiovascular Care, 2016. British Heart Foundation, heart attack statistics.
[4] Endometriosis UK, The State of Endometriosis Care in the UK, 2026. Royal College of Obstetricians and Gynaecologists, January 2026. NHS England, waiting list data, July 2025.
[5] NHS Business Services Authority, Medicines Used in Mental Health, England, 2025/26, July 2026.
[6] Li, D’Arcy and Meng, “Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies”, Psychological Medicine, 2016. Heim et al., Psychoneuroendocrinology, 2008.
[7] NICE, NG222, Depression in adults: treatment and management, 2022.
[8] NHS England, NHS Talking Therapies annual report 2024/25, and technical appendices. BMC Psychiatry, analysis of IAPT national data, 2019. NHS Digital, 2024.
[9] Read, Harrop, Geekie, Renton and Cunliffe, “A second independent audit of electroconvulsive therapy in England, 2019”, Psychology and Psychotherapy: Theory, Research and Practice, 2021.
[10] Read, Kirsch and McGrath, “Electroconvulsive Therapy for Depression: A Review of the Quality of ECT versus Sham ECT Trials and Meta-Analyses”, Ethical Human Psychology and Psychiatry, Vol. 21, No. 2, 2019. UK ECT Review Group, “Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis”, The Lancet, vol. 361, 2003.
[10a] Anand et al., “Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression”, New England Journal of Medicine, 2023. Mutz et al., BMJ, 2019.
[11] Sackeim et al.
[12] University of East London, campaign for an independent review of ECT, 2021.
[13] Cipriani et al., “Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder”, The Lancet, 2018.
[14] Morrison, Cunliffe, Hancock, Harrop, Johnstone and Read, “Electroconvulsive therapy and women: An international survey”, Health Care for Women International, November 2025. Luccarelli, Hart and McCoy, “Gender Representation in the ECT Workforce in the United States, 2013 to 2021”, The Journal of ECT, 2025.
[15] General Medical Council, register data, 2025. Medical Women’s Federation, reporting NHS Digital workforce data. Royal College of Psychiatrists, workforce data, 2019.
Sources checked at time of writing. Figures current as of August 2026.
