Electroconvulsive therapy in the continuation and maintenance treatment of depression: Systematic review and meta-analyses

Elias, Alby; Phutane, Vivek H.; Clarke, Sandy; Prudic, Joan

doi:10.1177/0004867417743343

Cited by 67 publications

(61 citation statements)

References 37 publications

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“…8 In a recent meta-analysis study that included five studies with 436 patients, continuation and maintenance ECT with pharmacotherapy showed fewer relapses and recurrences than did pharmacotherapy alone within a year after successful completion of ECT. 9 A meta-analysis study reported that the relapse rate within one year following ECT exceeded 50%, and when placebo only was given to the patients after the end of ECT, the relapse rate reached 84%. 8,10 Although results from randomized controlled studies are needed for more rigorous evidence, maintenance ECT alone or combination with medication seems to be a reasonable treatment option for preventing relapse after ECT.…”

Section: Results Maintenance Therapy For Preventing Relapse After Ectmentioning

confidence: 99%

Recent Updates on Electro-Convulsive Therapy in Patients with Depression

Park

Kim

et al. 2021

Psychiatry Investig

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Objective Electro-convulsive therapy (ECT) has been established as a treatment modality for patients with treatment-resistant depression and with some specific subtypes of depression. This narrative review intends to provide psychiatrists with the latest findings on the use of ECT in depression, devided into total eight sub-topics.Methods We searched PubMed for English-language articles using combined keywords and tried to analyze journals published from 1995–2020.Results Pharmacotherapy such as antidepressants or maintenance ECT is more effective than a placebo as prevention of recurrence after ECT. The use of ECT in treatment-resistant depression, depressed patients with suicidal risks, elderly depression, bipolar depression, psychotic depression, and depression during pregnancy or postpartum have therapeutic benefits. As possible mechanisms of ECT, the role of neurotransmitters such as serotonin, dopamine, gamma-aminobutyric acid (GABA), and other findings in the field of neurophysiology, neuro-immunology, and neurogenesis are also supported.Conclusion ECT is evolving toward reducing cognitive side effects and maximizing therapeutic effects. If robust evidence for ECT through randomized controlled studies are more established and the mechanism of ECT gets further clarified, the scope of its use in the treatment of depression will be more expanded in the future.

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Section: Results Maintenance Therapy For Preventing Relapse After Ectmentioning

confidence: 99%

Recent Updates on Electro-Convulsive Therapy in Patients with Depression

Park

Kim

et al. 2021

Psychiatry Investig

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“…In unserer Analyse war der rückfallpräventive Effekt der Kombination aus E-EKT und Pharmakotherapie der alleinigen Pharmakotherapie überlegen. Dies steht im Einklang mit anderen Studien [3,4,21] und zwei systematischen Reviews [22,23]. In den ersten drei Monaten nach der Akutbehandlung erlitten 40 % der Patienten ohne E-EKT in unserer Untersuchung Rückfälle vs. 10 % mit E-EKT (▶Abb.…”

Section: Diskussionunclassified

Risikofaktoren für Rückfall nach Elektrokonvulsionstherapie bei depressiven Erkrankungen

Grüter

Grözinger²

2018

Fortschr Neurol Psychiatr

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Zusammenfassung Ziel der Studie Eine wesentliche Herausforderung der Elektrokonvulsionstherapie (EKT) ist die Vermeidung von Rückfällen nach erfolgreicher Akutbehandlung. Hierfür wird zunehmend das Konzept der langsam ausschleichenden Erhaltungs-EKT propagiert. Das Ziel dieser Untersuchung war es, Risikofaktoren für Rückfälle nach EKT bei depressiven Erkrankungen zu identifizieren. Methodik Nach erfolgreicher Akutbehandlung einer depressiven Episode mit EKT wurde allen Patienten Erhaltungs-EKT nach einem festen Schema angeboten. Tatsächlich variierte die Anzahl der E-EKTs aufgrund unterschiedlicher Compliance im naturalistischen Setting. Alle Patienten mit einer Verlaufskontrolle von mindestens 6 Monaten wurden in der retrospektiven Analyse berücksichtigt (n = 82). Überlebensanalysen mit der Zeit bis zum Rückfall als abhängige Variable wurden benutzt, um den Einfluss der Risikofaktoren auf das Rückfallrisiko einzuschätzen. Ergebnisse 34,1 % der Patienten erlitten innerhalb von 6 Monaten einen Rückfall. Mit einem verminderten Rückfallrisiko assoziiert waren 1. Erhaltungs-EKT, besonders innerhalb der ersten 3 Monate, 2. erhöhte durchschnittliche Ladung während der Indexserie, 3. Wechsel der Elektrodenposition von unilateral auf bilateral während der Indexserie und 4. männliches Geschlecht. Die Sensitivitätsanalyse weist darauf hin, dass das geringere Rückfallrisiko von Männern gegenüber Frauen insbesondere in den ersten 3 Monaten besteht. Schlussfolgerung Erwartungsgemäß war Erhaltungs-EKT mit einer reduzierten Rückfallrate assoziiert, insbesondere die frühen Behandlungen nach der Indexserie. Daneben wurde ein Zusammenhang eines verminderten Rückfallrisikos mit einer höheren Ladung sowie dem Wechsel zu einer bilateralen Elektrodenposition während der Indexserie gefunden. Bei Frauen traten frühe Rückfälle vermehrt auf.

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“…Electroconvulsive therapy (ECT) is the most effective treatment for TRD, but it requires 6-18 treatments under general anesthesia. 8 ECT reduces psychiatric hospitalization rates, long-term suicide risk, and all-cause mortality. 9 However, ECT is also associated with significant side effects and adverse events including nausea, headache, muscle pain, oral lacerations, dental injuries, and persistent myalgia.…”

Section: Introductionmentioning

confidence: 99%

Cost–Utility Analysis of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Ontario

et al. 2019

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Objectives: To evaluate the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT), and combining both treatments in a stepped care pathway for patients with treatment-resistant depression (TRD) in Ontario. Methods: A cost–utility analysis evaluated the lifetime costs and benefits to society of rTMS and ECT as first-line treatments for TRD using a Markov model, which simulates the costs and health benefits of patients over their lifetime. Health states included acute treatment, maintenance treatment, remission, and severe depression. Treatment efficacy and health utility data were extracted and synthesized from randomized controlled trials and meta-analyses evaluating these techniques. Direct costing data were obtained from national and provincial costing databases. Indirect costs were derived from government records. Scenario, threshold, and probabilistic sensitivity analyses were performed to test robustness of the results. Results: rTMS dominated ECT, as it was less costly and produced better health outcomes, measured in quality-adjusted life years (QALYs), in the base case scenario. rTMS patients gained an average of 0.96 additional QALYs (equivalent to approximately 1 year in perfect health) over their lifetime with costs that were $46,094 less than ECT. rTMS remained dominant in the majority of scenario and threshold analyses. However, results from scenarios in which the model’s maximum lifetime allowance of rTMS treatment courses was substantially limited, the dominance of rTMS over ECT was attenuated. The scenario that showed the highest QALY gain (1.19) and the greatest cost-savings ($46,614) was when rTMS nonresponders switched to ECT. Conclusion: From a societal perspective utilizing a lifetime horizon, rTMS is a cost-effective first-line treatment option for TRD relative to ECT, as it is less expensive and produces better health outcomes. The reduced side effect profile and greater patient acceptability of rTMS that allow it to be administered more times than ECT in a patient’s lifetime may contribute to its cost-effectiveness.

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Electroconvulsive therapy in the continuation and maintenance treatment of depression: Systematic review and meta-analyses

Cited by 67 publications

References 37 publications

Recent Updates on Electro-Convulsive Therapy in Patients with Depression

Recent Updates on Electro-Convulsive Therapy in Patients with Depression

Risikofaktoren für Rückfall nach Elektrokonvulsionstherapie bei depressiven Erkrankungen

Cost–Utility Analysis of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Ontario

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