Evidence for the Continuing Benefits of Electroconvulsive Therapy

Abstract

Electroconvulsive therapy has been an important part of the psychiatric armamentarium for over 75 years. Although ECT is most often used as a treatment for depression, its benefits have also been demonstrated in patients of all ages with catatonia, mania, and, under some circumstances, schizophrenia and schizoaffective disorder (1). Early in its history, ECT was the only available somatic treatment that was effective for severe psychiatric illness. However, with older techniques for ECT administration, side effects (including effects on cognition) were common. With the advent of psychotropic agents and concerns about ECT tolerability, its use became less frequent. Negative media portrayals fueled stigma about ECT and added to controversies about appropriate use. Despite all this, ECT remains our "go to" treatmentthe approach that clinical studies and experience tell us is most likely to elicit a rapid and robust response, even with severe symptoms that have not responded to other interventions.As with virtually all treatments in medicine, there are aspects of ECT that could be improved further. To maintain ECT benefits while minimizing cognitive effects, active foci of investigation have included new approaches: changing stimulus parameters, modifying electrode placements, prescribing adjunctive medications, or administering psychotherapy. Another challenging aspect of ECT practice is helping individuals remain well once ECT has exerted a salutary effort. Studies have shown that treatment with lithium in combination with nortriptyline after an index course of ECT can reduce relapse rates compared with placebo (2). Other research shows lithium plus venlafaxine (3) or continuation ECT alone (4) to have relapse rates comparable to those for lithium plus nortriptyline. Even with these approaches, a substantial number of individuals will still have recurrent symptoms within 6 months of an acute ECT course. The articles by Kellner et al. (5,6) in this issue of the Journal examine whether continuation ECT in combination with medication can maintain the acute antidepressant effects of ECT with acceptable tolerability and greater efficacy than continuation medication treatment alone.In phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study (5), patients age 60 or older with unipolar depression received venlafaxine (in dosages of up to 225 mg/day) in combination with three-times-a-week right unilateral ultrabrief pulse ECT at a stimulus dose of six times seizure threshold. Of the 240 patients who began phase 1, remission was achieved in 61.8%, 28.3% did not complete the trial, and 10.0% were nonremitters. This remission rate was about twice that for antidepressants in comparable populations, although it was slightly lower than rates in previous studies that used brief pulse ECT. Also, compared with studies of antidepressants, ECT trials typically enroll patients with more severe symptoms (7), and phase 1 of the PRIDE trial was no exception. The mean Clinical Global Impressions severity score was in the "ma...

Polymorphisms in MicroRNA Genes Associated with Schizophrenia Susceptibility but Not with Effectiveness of MECT

“…MECT is an effective treatment to mood disorders and has been used in the field of psychiatry for seven decades [ 17 ]. Nowadays, MECT is used as an enhancement of antipsychotic treatment and to solve drug-resistant symptoms in SCZ [ 18 ].…”

Assessment of attitudes of patients with psychiatric disorders regarding electroconvulsive therapy as a treatment option

“…3 In spite of the fruitful use of ECT since 1938 4 and its positive contribution to treat conditions like affective disorders, psychosis and catatonia, the method has been subjected to divergent opinions among the practitioners, the public, the patients and even the politicians, making it a controversial and stigmatized procedure since its inception. 5,6 The negative public opinion has even led to the banning of ECT in some countries like Italy and Slovenia. 7,8 Due to the negative perception portrayed regarding ECT, this otherwise highly useful modality has remained underutilized.…”