Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression

Abstract

This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: "electroconvulsive elderly," "electroconvulsive geriatric," "ECT and elderly," and "ECT elderly cognition." The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients.

Association between hippocampal volume change and change in memory following electroconvulsive therapy in late‐life depression

“…Still, despite the possible learning effects and the current debate on the reliability of the MMSE , this considerable increase is worth mentioning. In general, no negative evolution is seen in memory performance, which is in line with other studies . Contradictory to common beliefs, ECT has no long‐term deleterious effects on memory performance, on the contrary, memory performance seems to transcend pretreatment levels.…”

“…A profound consideration of this study is the limited generalizability due to the old‐age of our sample. However, since ECT is an effective treatment for elderly suffering from severe mood disorders , , , this study is of value for many patients treated with ECT. Furthermore, patients with the most pronounced cognitive deficits before the start of the treatment could not participate or dropped out in our sample, resulting in a ‘completer bias’.…”

“…Both retrograde and anterograde amnesia are reported during or briefly after the ECT treatment . However, cognitive functions often improve and even transcend pretreatment levels once ECT is finished . In a review of 84 studies, a wide range of cognitive side‐effects associated with ECT was evident within the first 3 days following completion of the therapy .…”

“…Despite the fact that most adverse cognitive effects seem to be transient , memory loss is still the main complaint in patients who had ECT. Therefore, it is desirable to gain more insight into the mechanisms of ECT‐related cognitive dysfunction.…”

Acetylcholinesterase inhibitors for electroconvulsive therapy‐induced cognitive side effects: a systematic review

“…A common risk factor for the majority of ECTinduced side effects is advanced age (van Schaik et al, 2015, Oudega et al, 2014. However, a recent metaanalysis demonstrated that advanced age is associated with more rapid ECT response rates and higher remission rates in rapid responders (Haq et al, 2015;Rhebergen et al, 2015;Geduldig and Kellner, 2016;Rosen et al, 2016). Thus, older individuals, who benefit most from ECT, may on the other hand have the highest risk for ECT-induced cognitive side effects.…”