Electroconvulsive Therapy: Is Further Investigation Necessary?

Cg, Costello

doi:10.1177/070674377602100202

Cited by 4 publications

(3 citation statements)

References 11 publications

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Section: Mechanism Of the Antidepressant Effectmentioning

confidence: 87%

“…There were rather large differences between groups in pre-treatment ratings, but improvement scores were greater in the photoconvulsive and ECT groups than in the other 2 groups. However, a x 2 comparison of the ECT and placebo groups failed to reveal significant differences either at completion of the treatment or at follow-up (Costello, 1976). (c) Brill et al (1959) compared ECT administered in 3 different ways (without anaesthesia, with succinylcholine, and with thiopentone) with anaesthesia induced either by thiopentone or nitrous oxide (i.e.…”

Section: Mechanism Of the Antidepressant Effectmentioning

confidence: 99%

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The scientific status of electro-convulsive therapy

Crow¹

1979

Psychol. Med.

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Electro-convulsive therapy (ECT) has been available for just over 40 years, whereas neuroleptic drugs have recently celebrated their 25th anniversary. Yet much more is known of the magnitude and scope of effectiveness, the mechanism of action, and even the adverse effects, of neuroleptic drugs in the treatment of schizophrenia than of electro-convulsive therapy in depression. Research on drug therapy of schizophrenia has advanced rapidly in the past 15 years while clinical research on ECT has progressed little. Until recently, basic research on possible mechanisms of action was also very limited.It seems unlikely that this state of affairs presages the demise of convulsant therapy as a major treatment modality. Despite criticisms from a number of sources, most psychiatrists remain convinced that ECT has a unique place in the treatment of depression. Yet it is an entirely empirical treatment. In this respect it is far from unique in medicine; but it must be unusual for a treatment to remain widely used and so little understood for so long a period.Advances in understanding mechanisms of action are desirable but many purely clinical questions remain unanswered. The Department of Health and Social Security and the Royal College of Psychiatrists are ascertaining the extent to which ECT is now used in British hospitals. It seems possible that a number of smaller projects, if properly designed, could provide answers to some outstanding questions concerning the scope and indications for this treatment. Such answers might substantially influence current practice, based as it is on information from trials carried out when antidepressant medications were relatively new, and to a large extent upon the individual clinician's intuition. EFFECTIVENESS IN DEPRESSIONIn an attempt to obtain an overall view of the effectiveness of ECT in comparison with other therapies, Wechsler et al. (1965) summarized 153 studies published between 1958 and 1963 in American, British and Canadian journals, involving a total of 5864 patients. They present the figures shown in Table 1.Since many studies were uncontrolled, and these studies showed higher rates of improvement than those with a control group, these figures almost certainly exaggerate the effectiveness of antidepressant treatments, including ECT. More cogent perhaps is the contrast which these authors were able to demonstrate in the findings of studies dealing with depressions of recent onset and those which included mainly chronic depressions (but also some schizophrenic patients) (see Table 2). The superiority of both drugs and ECT over placebo is much less in the latter group.No firm conclusions can be drawn from a literature survey. Patient selection is uncontrolled and many studies in which ECT was compared directly with other treatments included small numbers of patients. The soundest basis for an assessment of the efficacy of ECT are 2 major controlled trials completed in the early 1960s. The first (Greenblatt et al. 1962(Greenblatt et al. , 1964, in the United States, included ...

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Section: Mechanism Of the Antidepressant Effectmentioning

confidence: 87%

Section: Mechanism Of the Antidepressant Effectmentioning

confidence: 99%

The scientific status of electro-convulsive therapy

Crow¹

1979

Psychol. Med.

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“…Unfortunately, the claims made about the therapeutic powers of ECT remain, at best, unproven (Costello, 1976;, and the means used for its application are still too often quite haphazard (Davies, Detre, Egger, Tucker and Wyman, 1971). Thus, what we now know about its likely cognitive costs reaffirms the pressing need for a very thorough and systematic appraisal of the supposed benefits of this mode of treatment, whose therapeutic value has been perhaps too long taken for granted.…”

Section: Discussionmentioning

confidence: 99%

The effects of electroconvulsive therapy on human learning and memory.

Robertson¹,

Inglis²

1977

Canadian Psychological Review / Psychologie Canadienne

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The effects of electroconvulsive therapy on human learning and memory are reviewed in terms of treatment variables (including number and frequency of treatments, characteristics of the convulsive agent, and different electrode placements), test procedures and task specific characteristics, and temporal parameters. Differences between the effects of bilateral and unilateral ECT may be due to the balance of verbal symbolic and nonverbal imaginal processes evoked by the range of stimuli used. Results have implications for the understanding of human brain-behaviour relationships, and for the cost-benefit evaluation of electrically induced convulsions as a form of psychiatric treatment. RESUME Analyse critique des effets produits par le traitement d'electrochoc sur I'apprentissage et la memoire: I'analyse touche aux variables du traitement (nombre et frequence des traitements, caracteristiques de I'electrochoc, disposition variee des electrodes), aux methodes de test et aux caracteristiques des taches, ainsi qu'aux parametres temporels. Les differences observees entre les effets produits par I'electrochoc bilateral ou unilateral peuvent etre dues a I'equilibre des processus symboliques verbaux et images non verbaux evoques par I'eventail res stimuli utilises. Les resultats ont des repercussions sur la comprehension des rapports entre le cervoau humain et le comportement ainsi que sur revaluation (couts et benefices) de I'electrochoc comme forme de traitement psychiatrique.

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