Cost and benefit in the choice of ECT schedule

Shapira, Baruch; Tubi, Nurith; Drexler, Heinz; Lidsky, D.; Calev, Avraham; Lerer, Bernard

doi:10.1192/bjp.172.1.44

Cited by 63 publications

(30 citation statements)

References 11 publications

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“…3 In Study 2, the number of real ECTs was limited to eight in both groups. 4 In both studies there was no significant difference in antidepressant outcome between the ECT × 2 and ECT × 3 regimens. Both groups improved significantly and to a similar degree at the end of the treatment course.…”

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confidence: 96%

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Time-dependent sensitization and ECT

Lerer¹,

Shapira

2001

Mol Psychiatry

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confidence: 96%

“…The time course of the effect of ECT differed significantly between the two schedules and clearly favored the more frequent schedule (ECT × 3). In these 3,4 and subsequent 5 analyses we clearly showed that the more rapid response of the ECT × 3 group was due to the greater frequency of real ECT administration.…”

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confidence: 99%

Time-dependent sensitization and ECT

Lerer¹,

Shapira

2001

Mol Psychiatry

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“…16,17 When the MeSH were associated with specific nosologies (depression, mania and schizophrenia), 185 RCT about depression, 19 about mania and 22 about schizophrenia were found. Of these, we selected only those that evaluated efficacy, indications and/or profile of ECT adverse effects.…”

Section: Indicationsmentioning

confidence: 99%

“…Patients with depression require, in general, from 6 to 12 sessions, and those with mania or schizophrenia may require a higher number of sessions. 16,18,55 Some past studies suggest that when the complete remission is reached, it is not necessary to submit the patient to additional sessions. [102][103][104][105] No consensus has been reached as to the maximum number of courses of ECT that a patient may be submitted to, nor there is a consensus about the indication for maintenance therapy.…”

Section: Efficacymentioning

confidence: 99%

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica

Moser

Lobato

Belmonte-de-Abreu

2005

Rev. psiquiatr. Rio Gd. Sul

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A eletroconvulsoterapia (ECT) consiste em tratamento biológico ainda não amplamente utilizado na prática psiquiátrica, devido aos inúmeros fatores que contribuem para uma resistência acerca do método. Objetivando sustentar, com embasamento científico, o emprego da ECT, agregamos evidências de sua eficácia, indicações, contra-indicações e efeitos adversos, advindas dos principais ensaios clínicos randomizados e meta-análises disponíveis na literatura médica atual sobre o tema (PubMed/MEDLINE, Cochrane).

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“…2 The comparisons of more versus less frequent ECT and high versus low dose ECT also addressed only the magnitude of antidepressant response. Evidence also suggests that more frequent ECT 3 and high dose ECT 4 are each associated with a faster response. A faster response is important because it reduces suffering, risk of suicide, duration of hospital stay, and treatment costs and may hasten return to work.…”

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confidence: 99%

Review: electroconvulsive therapy reduces depressive symptoms

Andrade¹

2003

Evidence-Based Medicine

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Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003;361:799-808. QUESTION: What are the benefits and harms of electroconvulsive therapy (ECT) in patients with depressive disorders? Data sourcesStudies were identified by searching Biological Abstracts (1985( to September 2000, CINAHL (1982 to January 2001, EMBASE/Excerpta Medica (1980-2000, LI-LACS (1982 to January 2001), Medline (1966-2000, PsycINFO (1887PsycINFO ( -2000, SIGLE (1980SIGLE ( -2000, and the Cochrane Library; and by reviewing reference lists and specialist textbooks. Study selectionRandomised controlled trials (RCTs) were selected if they compared ECT with no ECT, ECT with pharmacotherapy, or different types of ECT in patients with depressive illness. Data extractionReviewers independently extracted data on treatment comparisons, inclusion criteria, patient characteristics and co-treatment, and outcomes. Main outcome was change in symptoms on a continuous depressive symptom scale. Quality of RCTs was assessed on the basis of allocation concealment, masking, loss to follow up, and length of follow up. Main results73 RCTs met the selection criteria and were combined using a random effects model. ECT reduced depressive symptoms more than simulated ECT or pharmacotherapy (primary tricyclic antidepressants) (table). Bilateral electrode placement reduced depressive symptoms more than unilateral placement, and a higher dose of electrical stimulus was better than a lower dose (table). Frequency of treatment (1 v 3 times/wk and 2 v 3 times/ wk) and stimulus waveform (brief pulse v sinewave) had no effect on depressive symptoms (table).The effects of ECT on cognitive functioning were also reported. Results of the cognitive effects of ECT compared with pharmacotherapy were equivocal (2 trials). Patients treated with bilateral ECT had a longer time to recovery of orientation (6 trials), and greater impairment in retrograde (4 trials) and anterograde (7 trials) memory within 1 week than patients treated with unilateral ECT. More frequent ECT led to more cognitive impairment at the end of the treatment course (4 trials). Higher doses of ECT did not affect personal memory more than lower doses, but did result in some impairment of anterograde memory (5 trials). ConclusionsECT reduces depressive symptoms more than pharmacotherapy. Bilateral electrode placement is more effective than unilateral placement, and a higher dose is more effective than a lower dose. Electroconvulsive therapy (ECT) for depressive symptoms* COMMENTARYDespite widely varying methods and quality that potentially contribute statistical noise to the meta-analyses, ECT was superior to sham ECT and to drug therapy with regard to the magnitude of symptom improvement in the review by the UK ECT group. This supports the use of ECT, a treatment for which the National Institute for Clinical Excellence guidelines take an overly conservative position. 1Regrettably, more efficacious forms of ECT (bilateral ECT and high dose EC...

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Cost and benefit in the choice of ECT schedule

Abstract: Twice weekly administration is an optimum schedule for bilateral ECT unless clinical indications require the more rapid antidepressant effect of three times weekly treatment.

Cited by 63 publications

References 11 publications

Time-dependent sensitization and ECT

Time-dependent sensitization and ECT

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica

Review: electroconvulsive therapy reduces depressive symptoms

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