Electroconvulsive Therapy in Sweden 2013

Nordanskog, Pia; Hultén, Martin; Landén, Mikael; Lundberg, J.; Knorring, Lars von; Nordenskjöld, Axel

doi:10.1097/yct.0000000000000243

Cited by 77 publications

(49 citation statements)

References 27 publications

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“…Recent reports in international settings 11–15 show a wide variation in the prevalence of ECT use, with recent treated prevalence estimates ranging from 41 ECT patients/100,000 population in Sweden 11 to 1.1 ECT patients/100,000 population in Poland 2 . A recent systematic review and meta-analysis on the use of ECT internationally only included US studies dating from 1999 or earlier as no more recent studies were available 2 .…”

Section: Introductionmentioning

confidence: 99%

Electroconvulsive Therapy at a Veterans Health Administration Medical Center

Rosenheck¹

2017

J ECT

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Objectives Little epidemiologic research has examined the practice of electroconvulsive therapy (ECT). We investigated socio-demographic and clinical characteristics, service use, and psychotropic medication prescription patterns associated with ECT use at a Veterans Health Administration Medical Center. Methods Among veterans receiving specialty mental health services, we compared those who received ECT with those who did not using bivariate chi-square and t-tests and multivariate logistic regression. Results In fiscal year 2012, 11,117 veterans received specialty mental health services, of whom 50 received ECT (0.45%) in FY2012 or FY2013. Those who received ECT were more likely to be diagnosed with Major Depressive or Bipolar Disorders and had substantially higher levels of mental health service utilization (Cohen’s d>0.75) and psychotropic prescription fills, including antidepressants (Cohen’s d=2.66), antipsychotics (Cohen’s d=2.15), lithium (Cohen’s d=1.34), mood stabilizers (Cohen’s d=1.30), and anxiolytic/sedative/hypnotics (Cohen’s d=1.34). Conclusions Our findings suggest that ECT is used as a treatment of last resort, although available evidence and guidelines recommend wider use.

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Section: Introductionmentioning

confidence: 99%

Electroconvulsive Therapy at a Veterans Health Administration Medical Center

Rosenheck¹

2017

J ECT

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“…Case et al (10) reported that the total number of hospitals offering ECT has been declining. In international settings, ECT utilization varies widely across regions, with utilization estimates ranging from 1.1 ECT patients per 100,000 people in Poland (11) to 41 ECT patients per 100,000 people in Sweden (12). The most recent utilization estimates for the procedure in the United States date to 1999 or earlier (13) and vary widely by region, ranging from eight ECT patients per 100,000 people in California (14) in 1995 to 42 ECT patients per 100,000 people in New England in the same year (15).…”

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confidence: 99%

Identifying Recipients of Electroconvulsive Therapy: Data From Privately Insured Americans

Wilkinson¹,

Agbese²,

Leslie³

et al. 2018

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Objective: Despite the effectiveness of electroconvulsive therapy (ECT), limited epidemiologic research has been conducted to identify rates of ECT use and characteristics of patients who receive ECT. Sociodemographic and clinical characteristics associated with ECT use were examined among patients with mood disorders in the MarketScan commercial insurance claims database. Methods: Among individuals with major depressive disorder or bipolar disorder, sociodemographic and clinical characteristics of those who received ECT and those who did not were compared by using bivariate effect size comparisons and multivariate logistic regression. Results: Among unique individuals in the 2014 MarketScan database (N=47,258,528), the ECT utilization rate was 5.56 ECT patients per 100,000 in the population. Of the 969,277 patients with a mood disorder, 2,471 (.25%) received ECT. Those who received ECT had substantially higher rates of additional comorbid psychiatric disorders (risk ratio [RR] =5.70 for any additional psychiatric disorder), numbers of prescription fills for any psychotropic medication (Cohen’s d=.77), rates of any substance use disorder (RR=1.97), and total outpatient psychotherapy visits (Cohen’s d=.49). The proportion of patients with a mood disorder who received ECT in the West (.19%) was substantially lower than in other U.S. regions (.28%). This difference was almost entirely accounted for by one western state comprising 59.1% of patients in that region. Conclusions: Use of ECT is exceptionally uncommon and limited to patients with extensive multimorbidity and high levels of service use. ECT utilization is most limited in areas of the country where regulatory restrictions are greatest.

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“…Electroconvulsive therapy (ECT) was not included in the STAR*D-study, but is a well-established treatment for severe depression. In Sweden – a country with 9.5 million inhabitants – ∼4000 patients per year receive ECT ( 6 ). With repeated administrations, ECT is highly effective in relieving depressive symptoms: The percentages of patients achieving remission in two recently completed clinical trials was 64% ( 7 ) and 60% ( 8 ), respectively, although the results may be less favourable in clinical practice ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Effects of Hesel-coil deep transcranial magnetic stimulation for depression – a systematic review

Nordenskjöld

Mårtensson

Pettersson

et al. 2016

Nordic Journal of Psychiatry

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Background: One third of the depressed patients are not improved by antidepressant drugs and psychological treatments, and there is a need for additional treatments. Repetitive transcranial magnetic stimulation (rTMS) is being developed towards an alternative in treatment-resistant depression. Deep transcranial stimulation (dTMS) with the Hesel-coil (H-coil) is a further development of rTMS aiming to enhance the effect by getting the magnetic pulses to penetrate deeper into the brain. Aims: This report aims to assess the evidence-base for dTMS for depression. The report also includes an assessment of the ethical and economic aspects involved. Methods: A systematic review of the effects of H-coil dTMS on depression was conducted and the scientific support was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results: Only one controlled study was identified. In the sham-controlled randomized study, 212 participants with major depression that had not responded to antidepressant medication were enrolled. A two-point superiority in Hamilton Depression Rating Scale was observed in the dTMS arm vs the sham-arm at 4 weeks, but the difference was not statistically significant. No serious adverse events were reported apart from rare cases of epileptic seizures. Conclusions: The existing scientific support for H-coil dTMS therapy for depression is insufficient. The clinical implication is that the use of dTMS in depression should be restricted to the framework of clinical trials pending further studies. Fortunately, additional studies are underway and the evidence base should presumably improve over the next several years.

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Electroconvulsive Therapy in Sweden 2013

Cited by 77 publications

References 27 publications

Electroconvulsive Therapy at a Veterans Health Administration Medical Center

Electroconvulsive Therapy at a Veterans Health Administration Medical Center

Identifying Recipients of Electroconvulsive Therapy: Data From Privately Insured Americans

Effects of Hesel-coil deep transcranial magnetic stimulation for depression – a systematic review

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