Efficacy of ECT in Depression: A Meta-Analytic Review

Abstract

This study analyzed the efficacy of electroconvulsive therapy (ECT) in depression by means a meta-analytic review of randomized controlled trials that compared ECT with simulated ECT or placebo or antidepressant drugs and by a complementary meta-analytic review of nonrandomized controlled trials that compared ECT with antidepressants drugs. The review revealed a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCAs and ECT versus MAOIs. The nonrandomized controlled trials also revealed a significant statistical difference in favor of ECT when confronted with antidepressants drugs. Data analyzed suggest that ECT is a valid therapeutic tool for treatment of depression, including severe and resistant forms.

Biological Alterations in Depression

“…However, several observations have cast doubt on the major role of monoamines in MDD. In addition to the untimely manner in which elevation of monoamines occur with respect to symptom resolution (Baldessarini, 1989), treatments that do not elevate monoamine levels like electroconvulsive therapy (ECT) have been effectively shown to treat depression (Pagnin et al, 2004). The monoamine theory of depression was then modified to indicate that elevation of monoamines is the first step in a cascade of molecular events that ultimately leads to symptom improvement (Pineyro & Blier, 1999).…”

The History and Future of Deep Brain Stimulation

“…67 Of these, approximately 30% will fail adequate trials of up to four different classes of antidepressants. 68 An additional 35% will fail electroconvulsive therapy, 69 leaving potentially 2 million Americans with treatment refractory depression. Medtronic 65 and ANS systems (Advanced Neurologic Systems, Plano, TX; Clinicaltrials.gov, Identifier No.…”

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica

“…Of these, we selected only those that evaluated efficacy, indications and/or profile of ECT adverse effects. According to these studies and specialist's recommendations, 18 ECT is indicated in cases of: -Major depression (single or recurrent episode); [3][4][5][6][7][18][19][20][21][22][23] -Affective bipolar disorder (depressive, manic or mixed episodes); 18,[22][23] -Mild-schizophrenia (specially when the affective or catatonic symptomatology is prominent); 18,[24][25][26] -Schizoaffective disorder; 18,[24][25][26] -Schizophreniform disorder. 18,[24][25][26] 4 Some clinical diseases as the neuroleptic malignant syndrome, 27,28 Parkinson's disease, [29][30][31] epilepsy [32][33][34] and tardive dyskinesia, 13,35,36 have also been successfully managed with ECT.…”

“…85,86 In our research, an RCT 78 showed that ECT was better than paroxetine in the treatment of patients with non-responsive depression to two types of antidepressants. A meta-analysis by Pagnin et al 3 showed the ECT superiority not only as compared to the simulated ECT and placebo, but also compared to antidepressants in general, tricyclic antidepressants and inhibitors of monoamine oxidase inhibitors (MAOIs). Similar results were found in the systematic review by Kho et al, 4 who stated that there are no differences between sine wave and brief pulse machines.…”