Efficacy of ECT in Depression: A Meta-Analytic Review

Abstract

This study analyzed the efficacy of electroconvulsive therapy (ECT) in depression by means a meta-analytic review of randomized controlled trials that compared ECT with simulated ECT or placebo or antidepressant drugs and by a complementary meta-analytic review of nonrandomized controlled trials that compared ECT with antidepressants drugs. The review revealed a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCAs and ECT versus MAOIs. The nonrandomized controlled trials also revealed a significant statistical difference in favor of ECT when confronted with antidepressants drugs. Data analyzed suggest that ECT is a valid therapeutic tool for treatment of depression, including severe and resistant forms.A clinical reappraisal of electroconvulsive therapy (ECT) was conducted over the last decade after the observation that a proportion comprised between 20% and 40% of either unipolar or bipolar depressions did not respond satisfactorily to antidepressants (1, 2), despite the availability of more effective competitors for treatment of depression, like the selective serotonin reuptake inhibitors (SSRIs). An estimate of ECT efficacy can be obtained through the meta-analytic method that combines information from independent studies. Meta-analyses can use dichotomous or continuous data, with each type of data presenting advantages and disadvantages (3). Meta-analytic reviews that use continuous data produce reliable standardized weight mean differences, however, a decrease in a psychiatric scale does not necessarily means a clinical remission. A dichotomous measure, such as clinical response or no response, has a considerable advantage over derived statistical parameters because it employs raw data from each individual patients, allowing to know, for example, patients' proportions which achieve response with ECT in comparison other therapeutic tools. The objective of our study was to analyze the efficacy of ECT in depression by means a meta-analytic review of controlled clinical trials published between 1956 and 2003, using dichotomous data. METHODThis study reviews, by means of a MEDLINE search procedure using the key words electroconvulsive therapy and depression, all peer-reviewed publi-cations in English from January 1966 to February 2003. We also manually searched articles published prior to 1966 that might be relevant for our purpose. Among these studies, we selected those comparing ECT with simulated ECT, or placebo or antidepressants drugs. ECT trials conducted without comparison group were excluded from our analyses. Selected studies were classified and separated in nonrandomized controlled trials and randomized controlled trials.Like Janicak et al, (4) we used the studies in which it was possible to individualize each patient's response to treatment, using author's own criterion of response or no response. Basically, the response criterion was defined either as a reduction of at least 50% from baseline to end poin...

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