Mostly Male Doctors. Mostly Women Patients. No Trials Since 1985.
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. The extra time isn't a bonus. It’s most likely painful and difficult.
You've probably read the women's health gap pieces by now. Crash test dummies built on male bodies, menopause barely researched, all true, all told, many times. This piece looks a little deeper and ends at a treatment invented ninety years ago that puts electricity through the brain. Two thirds of those receiving it in England are women, more than a third of the time without their consent, and four in five of the doctors giving it are men. All of it on an evidence base of eleven trials, the last one run in 1985. Few people talk about it, but I’m going to because it’s deeply disturbing.
This isn't just some random disparity. 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. That's the corridor, and it has several stages.
It starts with pain. 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. Same pain, different prescription, documented across decades in Caroline Criado Perez's Invisible Women [2].
It continues with hearts. 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]. This is not a rare event finding a rare failure: 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]. The wrong diagnoses weren't random either. Women's heart attacks got labelled as anxiety, indigestion or panic. The body said "cardiac". The system heard "emotional".
The bias also runs through the conditions only women get. 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]. Nine years is not a delay. Nine years is a childhood. So, instead of answers, what do women get in the meantime?
The prescribing data answers it clearly. 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, none of which is in dispute here. But a gap that size, sitting on top of everything above it, is not a gap in serotonin but a gap in what the system does when a woman says something is wrong.
For a lot of women, the story starts long before the GP's desk. 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]. A lot of women's despair has a cause, and the cause often has a face. What a woman in that crisis needs first is to be heard, and NICE's own guidance agrees: 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]. So she gets medication aimed at her reaction instead of help with what happened to her. When it doesn't work, and aimed at the wrong target it often can't, she becomes "treatment-resistant", which simply means two courses of antidepressants have failed. Nothing new was found in her. Things were tried on her. 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]. Before anyone asks whether that's just what doctors look like, it isn't any more: 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, and sharpening as it goes: the more ECT a doctor gives, the more likely he is to be a man [14].
Whether you get it depends less on what's wrong with you than on where you live and who you see: 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]. Not a system with a standard. 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 but not reassuring: across studies, between 12% and 55% of recipients report persistent or permanent memory loss, with women and older people, precisely 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 kinds are anecdotal. That's the scandal. Ninety years into using this treatment, on a course of electricity to the brain given mostly to older women and often without their consent, the honest summary of the evidence is this: six small trials from before 1985 showing a large effect that had gone by six months, and testimony on both sides ever since. The call for an independent review isn't a fringe position, it's 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. Look down the corridor, at the pain read as emotion, the heart attacks read as panic, the nine undiagnosed years, the two-to-one prescribing, and at the far end a treatment flowing mostly into older women, often unconsenting, on eleven trials and a promise. The word may well have retired, but the routing didn't.
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. It's a case against a system that hears a woman's body, has men treat her mind, then calls its own failure her resistance. Women aren't living longer than men in any way that counts. We're ill longer, and we're ill in a system built to ask what's wrong with her rather than what happened to her.
The first treatment for a woman's pain is believing her.
The Receipts //
[1] Office for National Statistics, National life tables, UK, 2022 to 2024 (published December 2025): life expectancy at birth 83.0 years for females, 79.1 for males. ONS, Health state life expectancies, UK, 2022 to 2024 (published 19 February 2026): healthy life expectancy 60.9 years for females, 60.7 for males; females expected to spend 73% of life in good health, males 77%.
[2] Caroline Criado Perez, Invisible Women: Exposing Data Bias in a World Designed for Men, 2019, documenting studies from the 1980s and 1990s in which men reporting pain received pain medication while women received sedatives, and a 2014 study in which clinicians treating identical hypothetical back-pain patients recommended antidepressants more often for women. Original studies cited therein.
[3] University of Leeds, using the UK national heart attack register MINAP: 564,412 patients in England and Wales, 2004 to 2013; women 50% more likely than men to receive a wrong initial diagnosis (59% for STEMI); misdiagnosed patients at 70% increased risk of death at 30 days. Published in the European Heart Journal: Acute Cardiovascular Care, 2016, part-funded by the British Heart Foundation. BHF figures: 33,000 women admitted with heart attack yearly in the UK, one every 16 minutes; coronary heart disease kills twice as many women as breast cancer.
[4] Endometriosis UK, The State of Endometriosis Care in the UK, 2026 report, based on 3,075 people diagnosed since 2015: average time from first GP visit to diagnosis 9 years 4 months, UK-wide, worsening; Royal College of Obstetricians and Gynaecologists, January 2026: 743,312 women waiting for gynaecology care across the UK (December 2025 data). NHS England, July 2025: gynaecology the largest specialty on the waiting list for people aged 18 to 64 in England. Prevalence 1 in 10: Endometriosis UK.
[5] NHS Business Services Authority, Medicines Used in Mental Health, England, 2025/26 (published July 2026): 5.9 million female and 3.2 million male patients prescribed antidepressants; females 65% of all patients; 71% of 15 to 19 year olds prescribed antidepressants were female.
[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: pooled odds ratio 2.03 for depression. Heim et al., Psychoneuroendocrinology, 2008: childhood trauma described as a potent risk factor for adult depression.
[7] NICE guideline NG222, Depression in adults: treatment and management, 2022: for less severe depression, psychological interventions recommended first line; antidepressant medication not the routine first offer unless the person's preference.
[8] NHS England, NHS Talking Therapies annual report 2024/25: 1.81 million people referred, 670,419 finishing a course of treatment; the official definition of finishing a course of treatment is attending at least two treatment appointments (NHS Talking Therapies annual report technical appendices, 2024/25); on that definition, most non-completers fail to attend the first appointment or stop after one session (analysis of IAPT national data, BMC Psychiatry, 2019); low-intensity treatment is typically four to six brief sessions, with a national average of 4.6 appointments attended (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: approximately 2,500 people receiving ECT annually in England; 67% women; 58% over 60; 37% given without consent under the Mental Health Act; 47-fold difference in usage between highest and lowest trusts; Freedom of Information requests to 56 NHS trusts, 37 responding, only one able to report how many patients received psychological therapy first as NICE guidelines require. The same paper records ECT machine manufacturer Somatics adding permanent brain damage to its risk disclosures in 2018.
[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: eleven ECT versus sham trials ever conducted, none since 1985; the five supportive meta-analyses each built on between one and seven of them; approximately one million people worldwide receive ECT annually; persistent or permanent memory loss reported by between 12% and 55% of recipients across studies. This review is contested: published critiques dispute its quality scale and conclusions, and its authors' position is a minority one within psychiatry. Stated here as their findings. The main review supporting ECT is UK ECT Review Group, "Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis," The Lancet, volume 361, pages 799 to 808, 2003: six sham-controlled trials, 256 patients, standardised effect size 0.91 in favour of real ECT at the end of the course, with no significant difference at six months; the review describes most included trials as small, typically 40 to 60 participants, with poor quality of reporting.
[10a] Anand et al., "Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression," New England Journal of Medicine, 2023 (ELEKT-D): 403 patients randomised, open-label; ketamine noninferior to ECT, 55.4% against 41.2% response; ECT associated with reduced memory recall at three weeks, recovered by one month. Mutz et al., BMJ, 2019: network meta-analysis of 113 trials of non-surgical brain stimulation; bitemporal and high-dose right unilateral ECT ranked highest; 83% of included trials rated low or unclear risk of bias.
[11] Sackeim et al.
[12] University of East London, 2021: the campaign for an independent government review of ECT, drawing on the audits above, supported by Mind, the Royal College of Nursing, the Association of Clinical Psychologists and Headway, the brain injury association.
[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: a systematic review and network meta-analysis of 522 double-blind randomised controlled trials, 116,477 participants.
[14] Morrison, Cunliffe, Hancock, Harrop, Johnstone and Read, "Electroconvulsive therapy and women: An international survey," Health Care for Women International, November 2025: 858 ECT recipients from 44 countries; 73% women; 81% of the psychiatrists administering ECT were men, 88% in the USA; a male psychiatrist treating a female patient thirteen times more common than the reverse across the survey, twenty-five times in the USA; women reporting worse outcomes, greater memory loss, less information and more coercion; 15% of women against 29% of men saying they would have ECT again. Self-selected online survey; stated here as its findings. American workforce data: Luccarelli, Hart and McCoy, "Gender Representation in the ECT Workforce in the United States, 2013 to 2021," The Journal of ECT, 2025: men were 61% of psychiatrists billing Medicare, 77% of those billing for ECT, and 84% of high-volume ECT providers.
[15] General Medical Council register data and workforce reporting, 2025: for the first time, more female than male doctors licensed to practise in the UK. NHS Digital workforce data as reported by the Medical Women's Federation: women now 51% of doctors specialising in psychiatry. Royal College of Psychiatrists workforce data: women held approximately 45% of substantive consultant psychiatrist posts, 2019.
Sources checked at time of writing. Figures current as of August 2026.
