A comparative study of electroconvulsive therapy among the elderly and adult patients with depressive disorder

Abstract

Aim: The present study aimed to compare the clinical profile, indications for electroconvulsive therapy (ECT), effectiveness of ECT, and complications associated with the use of ECT among elderly and adult patients. Methodology: Using a retrospective study design, data from patients with a diagnosis of unipolar depression, who received ECT between January 2013 and March 2023 was extracted. Based on the age at the time of receiving ECT, the study sample was divided into adult (age <60 years) and elderly (≥60 years) groups and compared. Results: The study included data from 1144 patients with depression. Of them, 371 (32.4%) patients were aged 60 years or above. Compared to the adult group, a significantly higher number of patients in the elderly group were diagnosed with recurrent depressive disorder (P < 0.001), had psychotic symptoms (P < 0.001), and had at least one medical comorbidity. Compared to adult patients, elderly depressed patients had longer total lifetime duration of illness (P < 0.001) and longer duration of current symptoms (P = 0.012). In terms of indications for ECT, the elderly patients had a higher frequency of poor response to the pharmacological treatment (P = 0.003) and a lower frequency of suicidality and attempts at self-harm (P < 0.001). Compared to adults, elderly patients received a higher number of effective ECTs (P = 0.04). There were no differences between the two groups in terms of the reason for stopping ECT and the extent of improvement. However, a higher proportion of the elderly experienced complications related to ECT and received repeat ECT courses (P = 0.003) and continuation ECT (P < 0.001). Conclusion: The present study shows that there are some differences between the elderly and adult patients with depression in terms of indications for ECT, side effects related to ECT, need for multiple courses of ECT, and continuation ECT. However, the efficacy of ECT does not differ between the two groups.