Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies

Abstract

Real ECT is probably more effective than sham ECT, but as stimulus parameters have an important influence on efficacy, low-dose unilateral ECT is no more effective than sham ECT. ECT is probably more effective than pharmacotherapy in the short term and limited evidence suggests that ECT is more effective than repetitive transcranial magnetic stimulation. Tricyclic antidepressants (TCAs) may improve the antidepressant effect of ECT during the course of treatment. Continuation pharmacotherapy with TCAs combined with lithium in people who have responded to ECT reduces the rate of relapses. Overall, gains in the efficacy of the intervention depending on the stimulus parameters of ECT are achieved only at the expense of an increased risk of cognitive side-effects. Limited evidence suggests these effects do not last beyond 6 months, but there is no evidence examining the longer term cognitive effects of ECT. There is little evidence of the long-term efficacy of ECT. ECT either combined with antipsychotic medication or as a monotherapy is not more effective than antipsychotic medication in people with schizophrenia. More research is needed to examine the long-term efficacy of ECT and the effectiveness of post-ECT pharmacotherapy, the short-term and longer term cognitive side-effects of ECT, and the impact of ECT on suicide and all-cause mortality. Further work is needed to examine the information needs of people deciding whether to accept ECT and how their decision-making can be facilitated. More research is also needed on the mechanism of action of ECT. Finally, the quality of reporting of trials in this area would be vastly improved by strict adherence to the Consolidated Standards of Reporting Trials recommendations. Economic analysis may identify areas in which research would be best targeted by identifying parameters where reducing the level of uncertainty would have the most effect in helping to make the decision on whether ECT is a cost-effective treatment.

In vivo Effect of Antidepressants on [3H]paroxetine Binding to Serotonin Transporters in Rat Brain

“…The selective SSRIs and the tricyclic antidepressants (TCAs) represent two major classes of therapeutics used for treatment of a wide range of behavioral and neurologic disorders from depression to autism, and schizophrenia [24,25]. The classically recognized action of these drugs is to block uptake of serotonin (5-HT) by the membrane 5-HT transporter (SERT), which results in an increase in synaptic 5-HT availability.…”

The costs of schizophrenia in Spain

“…The real annual incidence of schizophrenia in Spain is very close to 0.2 [32]. On the other hand, there is a coincidence with respect to the strong impact of illness, both in economic terms as well as the influence it has on patients' quality of life [15,22]. It is therefore reasonable to address the issue of the amount of resources invested in treating schizophrenia and what the overall cost is for society as a whole.…”

Region-specific transcriptional changes following the three antidepressant treatments electro convulsive therapy, sleep deprivation and fluoxetine

“…In contrast to drugs affecting the monoaminergic system, sleep deprivation (SD) and electro convulsive therapy (ECT) are two clinically well-documented, robust, fast-acting methods for treatment of severely depressed patients. [15][16][17][18][19][20] Both treatments require hospitalization and have been extensively used over the past century. However, the molecular and cellular mechanisms underlying their antidepressant effects are poorly understood.…”