Declining Use of Electroconvulsive Therapy in United States General Hospitals

Case, Brady G.; Bertollo, David N.; Laska, Eugene; Price, Lawrence H.; Siegel, Carole; Olfson, Mark; Marcus, Steven C.

doi:10.1016/j.biopsych.2012.09.005

Cited by 76 publications

(67 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These results also highlight the importance of using guidelines and standard protocols for ECT in pre-and post-treatment phases. An interesting study came out recently showing a decline in the use of ECT (34). Despite there being several reasons for this decline, considering also the results of our study, high relapse rates might result in diminished ECT use in future.…”

Section: Discussionsupporting

confidence: 53%

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Çakιr¹,

Çağlar²

2017

Arch Neuropsychiatr

View full text Add to dashboard Cite

Introduction: Electroconvulsive therapy (ECT) is known to be an effective option in the treatment of mood disorders, especially resistant depression. However, the remission achieved by ECT was reported to be not long lasting enough. The aim of the present study was to investigate the relapse/recurrence rates and associated risk factors during the first year after ECT in patients diagnosed with mood disorders.Methods: In a naturalistic observation, patients diagnosed with unipolar depressive disorder or a depressive episode of bipolar disorder and who had achieved remission by ECT were followed up for at least one year. The patients were evaluated with structured interviews during the follow-up period. The relapse/recurrence rates were the primary outcome measurements, while hospitalization and suicide attempts were the secondary outcome measurements. The remitted and non-remitted patients were compared regarding the clinical features, ECT, and pharmacological variables.Results: Fifty of 62 patients who had achieved remission with ECT completed the one year follow-up period. Thirty-three patients (66%) had relapse/recurrence, while 17 (34%) patients remained in remission. The relapse rates were similar in patients with unipolar depression and bipolar disorders. The mean number of ECT sessions was higher in relapsed patients with bipolar disorders. Multiple episodes were more frequent in non-remitted patients with unipolar depression. Comorbid psychiatric diagnosis was higher in non-remitted patients with unipolar and bipolar disorders. Conclusion:The relapse/recurrence rate was found to be fairly high in the first year of follow-up in patients who had achieved remission with ECT. ECT decisions should be made carefully in patients with comorbid psychiatric diagnosis and multiple episodes as these are more risky. The ECT application procedure and successive maintenance treatment (maintenance ECT, pharmacotherapy, and psychotherapy) should be planned to sustain the remission for patients with mood disorders in long-term follow-up.Keywords: Electroconvulsive therapy, mood disorders, relapse, remission, major depression Arch Neuropsychiatry 2017; 54: 196-201 • DOI: 10.5152/npa.2016.14845 Electroconvulsive ABSTRACT INTRODUCTONThe efficacy of pharmacotherapy in mood disorders is not satisfactory, and the desired remission rates are not currently achieved in either unipolar (UD) or bipolar disorders (BP) (1,2,3). Electroconvulsive therapy (ECT) has been used for a long time with successful response and remission rates; 80-90% of patients experience an improvement, and the efficacy of ECT has been established to be between 60% and 90% regarding acute response in treatment-resistant depression (3,4,5,6,7). ECT is also considered to be an effective treatment in bipolar depression and is indicated to be equally effective in unipolar and bipolar depression (8,9,10). The effectiveness of ECT in the treatment of UD and BP has also been reported, and it is recommended by guidelines (11,12,13,14). However, the literature data...

show abstract

Section: Discussionsupporting

confidence: 53%

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Çakιr¹,

Çağlar²

2017

Arch Neuropsychiatr

View full text Add to dashboard Cite

show abstract

“…Recent reports suggest that fewer facilities offer ECT. 12 Anecdotally, many of our TRD patients reported never having been offered ECT (no recorded incidence). Recent reviews suggest lack of MAOI marketing, clinician fears (of medical complications), and no experience in MAOI use as possible reasons for MAOI underuse.…”

Section: J Clin Psychiatry 76:11 November 2015mentioning

confidence: 91%

Clinical Characteristics and Management of Treatment-Resistant Depression

Conway

Gebara²,

Walker³

et al. 2015

J. Clin. Psychiatry

View full text Add to dashboard Cite

To the Editor: Approximately one-third of patients with major depressive disorder (MDD) are treatment resistant. 1,2 Despite high prevalence, the clinical characteristics and management of treatment-resistant depression (TRD) are not well described. We present a comprehensive clinical description of a case series of 79 well-characterized patients with TRD referred to a university-based TRD specialty clinic.Method. Of 104 patients referred to our TRD clinic from 2009 to 2014, 79 met clinic inclusion criteria: DSM-IV-TR-defined MDD with resistance to ≥ 3 antidepressant trials of adequate dose and duration and no diagnoses of bipolar I or II disorder, personality disorder, psychotic disorder, or alcohol or drug abuse/dependence. Medical records for psychiatric treatments within at least 5 years were obtained. Psychiatric history, including symptom, clinical, family, and treatment information, was obtained at the initial visit. Patients completed the Montgomery-Asberg Depression Rating Scale (MADRS). 3 Institutional review board approval and patient consent were obtained for research use of data.Results. Of the 79 patients, 67% (n = 53) were women; the mean age was 49.3 years (SD = 14.2). One-third (n = 26) were receiving disability support. The mean age at MDD onset was 24.3 years (SD = 13.8), with 50% of patients reporting MDD onset after age 18. The mean number of lifetime MDD episodes was 2.6 (SD = 1.7), with 70% (n = 55) of patients reporting ≥ 2 episodes; 30% (n = 24) reported 1 sustained MDD episode. The mean number of lifetime MDD years was 18.6 (SD = 10.0), with 51% (n = 40) of patients reporting ≥ 18 years. Most patients, 63% (n = 50), reported at least 1 psychiatric hospitalization; 21% (n = 17) reported ≥ 4 hospitalizations (maximum = 20). Of those hospitalized at least once, the mean number of hospitalizations was 3.8 (SD = 4.3); 43% (n = 34) of all patients reported ≥ 2 hospitalizations. At least 1

show abstract

“…The rate of use in Germany 2008 was found to be as low as 3.5/ 100 000 but increasing (Loh et al 2013). This is in contrast to a recent study from the United States, where inpatient hospital care including ECT was estimated to be 7.2/100 000 and declining (Case et al 2013). Although it seems that Sweden is a country with high rate of use of ECT in a global perspective, using occasional national surveys or a national mandatory register can produce bias in comparisons between countries.…”

Section: Clinical Aspectsmentioning

confidence: 59%

On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

Nordanskog¹

2015

View full text Add to dashboard Cite

Electroconvulsive therapy (ECT) is used worldwide to treat severe mental disorders. The most common mental disorder, and the third leading cause of disease burden in the world is depression. The clinical efficacy of ECT for severe depression is well-established. However, both the pathophysiology of depression and the mechanism of action of ECT remain elusive. The main aims of this thesis are to address the following issues: 1) the use and practice of ECT in Sweden has not been systematically evaluated since 1975, 2) cognitive side-effects (memory disturbances) are a major concern with ECT and 3) the mechanism of action of ECT remain elusive. The neurobiological aspects of ECT focus on two hypotheses. First, the recent years´ preclinical studies that have provided evidence that ECT induces hippocampal cell proliferation, including neurogenesis. Second, that enhanced functional inhibition of neuronal activity is a key feature. Current use and practice of ECT in Sweden (paper I) is based on data from the national quality register for ECT, the mandatory patient register of the National Board of Health and Welfare and a survey. Treated person rate (TPR) in Sweden 2013 was found to be 41 individuals / 100 000, and thus unchanged since the latest systematic investigation in Sweden 1975. In more than 70% of treatment series the indication was a depressive episode. The selection of patients for ECT and treatment technique in Sweden was similar to that in other western countries, but the consent procedure and the involvement of nurses and nursing assistants in the delivery of ECT differ. Data also shows that there is room for improvement in both the specificity of use and availability of ECT. The second study in this thesis is a longitudinal observational trial where 12 (paper II and III) and 14 (paper IV) patients with depression referred for ECT were investigated. Patients underwent a 3 T MRI structural scanning and DSC-MRI perfusion, a neuropsychological test battery and clinical ratings before ECT, within one to two weeks after ECT and after 6 and 12 months. In line with preclinical findings and the plasticity hypothesis of mechanism of action of ECT, the hippocampal volume increased after ECT in patients with depression. However, this increase was transient and returned to baseline levels within 6 months. No correlation was found between volumetric changes and clinical effect or cognitive outcome. Instead our results suggested an association to the number of treatments, without relation to the side of stimulation. A right-sided decrease in frontal blood flow distinguished remission from non-remission after ECT. There were significant impairments in verbal episodic memory and verbal fluency within one week after ending the ECT course, but these impairments were transient and no persistent cognitive impairments were seen during the follow-up. In summary, this thesis present the first update on the use and practice of ECT in Sweden in the last 40 years as well as a pioneering MRI-study on the hippocampal volume increase...

show abstract

Declining Use of Electroconvulsive Therapy in United States General Hospitals

Cited by 76 publications

References 19 publications

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Clinical Characteristics and Management of Treatment-Resistant Depression

On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

Contact Info

Product

Resources

About