Status of electroconvulsive therapy: Review of the outcome literature.

Electroconvulsive Therapy in Octogenarians

“…Confusion was the most frequent complication in both groups and tended to be more frequent in the older group. It has been previously well documented that older patients have been at risk for decreased cognitive function following ECT 5 , 35 . In one study of ECT in 45 older patients, 55% developed cognitive dysfunction severe enough to cause a delay in treatment, with substantial increases in the length of hospital stay 36 …”

“…It has been estimated that 60% to 70% of depressed patients respond to chemical antidepressant treatment within 2 to 3 weeks and, among those who fail to respond to initial treatment, only 15% to 25% respond to a second antidepressant drug 3 , 4 . Patients who fail to respond to chemical antidepressant treatment often still respond to ECT; in one study, remission occurred in 80% to 85% of nonresponders 2 , 5 . However, biologic, psychological, and social factors, as well as chronic illnesses, also place the older population at increased risk, not only for depressive disorders but also for the morbidity and mortality associated with ECT, such as cardiovascular events, falls, memory loss, confusion, and death 6 – 9…”

Electroconvulsive Therapy and Suicide

“…Scovern and Kilmann (1980) summarize outcome studies with ECT: “The most sophisticated of the studies from a methodologic viewpoint … are remarkably consistent in demonstrating the superiority of ECT for depression” (p. 281). Double‐blind and controlled studies, conducted in two different eras over the past quarter century, have confirmed the effectiveness of ECT in the treatment of depressive disorders.…”

“…Over the next 20 years, these drug treatments, usually employing tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs), largely replaced ECT. This is surprising, because extensive reviews of the effectiveness of these two treatment modalities have been unable to document any well‐designed study in which the antidepressant medications were more effective than the ECT on measures including rapidity of response, discharge rate, degree of improvement, and duration of hospitalization (Barton, 1977; Fink, 1978; Scovern & Kilmann, 1980; Turek & Hanlon, 1977). The two largest and best‐designed trials comparing drug therapies and ECT (Greenblatt, Grosser, & Wechsler, 1964; Medical Research Council, 1965) reported a clear advantage in short‐term outcome to those patients who received ECT, although the Medical Research Council's trial found it only for women.…”

The Role of Electroconvulsive Therapy in the Treatment of Depression in the Elderly

“…Electroconvulsive therapy (ECT), as practiced today, is the electrical induction of a series of grand‐mal seizures, generally six to ten, in patients with certain susceptible psychiatric disorders 1,3 . With respect to the management of major depressive episodes, ECT still remains the most effective form of treatment at our disposal 4 . It is important to realize that it is the seizure, rather than the electrical stimulus itself, that is therapeutic.…”