Suicidal ideation and ECT, ECT and suicidal ideation: A register study

Abstract

Objective Although electroconvulsive therapy (ECT) is anti‐suicidal, it is not known whether the presence of suicidal ideation (SI) at baseline predicts response and remission after ECT. The aim of the study was to analyze the impact of baseline SI on response and remission following ECT treatment in a large sample of patients with depression and to assess SI before and after ECT. Methods This population‐based register study used data from the Swedish National Quality Register for ECT and the Swedish Patient Register. Patients aged 18 years or older who had received ECT for a unipolar or bipolar depressive episode between 2011 and 2018 were included in the study. SI was defined as a score of ≥4 on the last item of the Montgomery–Åsberg Depression Rating Scale – Self Assessment (MADRS‐S). Using a logistic regression model, SI at baseline was used to predict response and remission following ECT, while controlling for depression severity, psychotic symptoms, presence of a comorbid personality disorder, age, sex, electrode position, unipolar or bipolar disorder, and number of previous suicide attempts at baseline. Results In patients who exhibited SI at baseline, 53.7% (N = 632) of cases showed a response to ECT, whereas 68.4% (N = 690) of patients without SI showed a response. In addition, 27.2% (N = 320) of cases with SI achieved remission, whereas 48.5% (N = 489) of cases without SI achieved remission. The odds of achieving response and remission for patients with SI were 0.75 and 0.58 times, respectively, those for patients without SI. Of the 1178 patients with pre‐treatment SI, 75.64% (N = 891) exhibited no SI at the end of treatment. Moreover, in this subgroup, the presence of a personality disorder, higher MADRS‐S‐score, and younger age were associated with persistent SI. Conclusion The presence of SI was associated with lower ECT response and remission rates. Nevertheless, depressive symptoms and SI were reduced in a large proportion of patients across both patient groups. Clinicians should be aware of the lower likelihood of achieving a successful outcome following ECT in younger patients who present with a non‐psychotic depressive episode, SI, and (suspected) personality disorders. More research is warranted regarding if these patients can achieve similar or better results with other treatments.

A retrospective case series of electroconvulsive therapy in the management of depression and suicidal symptoms in adolescents

“…Sienaert et al. (2022) found the response rate of ECT for MDD adults with SI was 53.7%, but in MDD adults without SI, the response rate was 68.5%.…”

“…For MDD adolescents with suicidal symptoms, previous studies showed worse outcome compared with MDD without suicidal symptoms (Grover et al, 2013;Puffer et al, 2016;Zhang et al, 2012), but we don't know the response rate of different suicidal symptoms, such as SI and SA, and if they showed different clinical outcome based on ECT. Sienaert et al (2022) found the response rate of ECT for MDD adults with SI was 53.7%, but in MDD adults without SI, the response rate was 68.5%, and they did not discuss the response rate of SA. To our best knowledge, there are no randomized controlled trials to determine the efficacy of ECT in adolescents with depression and suicidal symptoms, so we try to find out the efficacy and safety in a retrospective series of adolescents hospitalized with different suicidal symptoms.…”

“…Sienaert et al. (2022) found the response rate of ECT for MDD adults with SI was 53.7%, but in MDD adults without SI, the response rate was 68.5%, and they did not discuss the response rate of SA. To our best knowledge, there are no randomized controlled trials to determine the efficacy of ECT in adolescents with depression and suicidal symptoms, so we try to find out the efficacy and safety in a retrospective series of adolescents hospitalized with different suicidal symptoms.…”

Comparative efficacy, cognitive effects and acceptability of electroconvulsive therapies for the treatment of depression: protocol for a systematic review and network meta-analysis

“…Treatment remission rates may be as high as 60%-70%. 25 26 Further, ECT rapidly reduces suicidal ideation, [27][28][29] death by suicide 30 and significantly improves quality of life. 31 The efficacy, safety and acceptability of modern ECT practices are the result of several major advances in treatment delivery since the technique's development in the 1930s.…”

Risk factors for suicide following treatment with electroconvulsive therapy: A nationwide study of 11,780 patients

“…The anti-suicidal effect of ECT across mental disorders is well-established [6][7][8][9][10][11][12][13][14][15][16]. However, because the "baseline" risk of suicide among patients receiving ECT is highly elevated, suicide remains a relatively common cause of death for those having received ECT [17][18][19].…”