Identifying Recipients of Electroconvulsive Therapy: Data From Privately Insured Americans

Abstract

Objective: Despite the effectiveness of electroconvulsive therapy (ECT), limited epidemiologic research has been conducted to identify rates of ECT use and characteristics of patients who receive ECT. Sociodemographic and clinical characteristics associated with ECT use were examined among patients with mood disorders in the MarketScan commercial insurance claims database. Methods: Among individuals with major depressive disorder or bipolar disorder, sociodemographic and clinical characteristics of those who received ECT and those who did not were compared by using bivariate effect size comparisons and multivariate logistic regression. Results: Among unique individuals in the 2014 MarketScan database (N=47,258,528), the ECT utilization rate was 5.56 ECT patients per 100,000 in the population. Of the 969,277 patients with a mood disorder, 2,471 (.25%) received ECT. Those who received ECT had substantially higher rates of additional comorbid psychiatric disorders (risk ratio [RR] =5.70 for any additional psychiatric disorder), numbers of prescription fills for any psychotropic medication (Cohen’s d=.77), rates of any substance use disorder (RR=1.97), and total outpatient psychotherapy visits (Cohen’s d=.49). The proportion of patients with a mood disorder who received ECT in the West (.19%) was substantially lower than in other U.S. regions (.28%). This difference was almost entirely accounted for by one western state comprising 59.1% of patients in that region. Conclusions: Use of ECT is exceptionally uncommon and limited to patients with extensive multimorbidity and high levels of service use. ECT utilization is most limited in areas of the country where regulatory restrictions are greatest.

ECT beyond unipolar major depression: systematic review and meta‐analysis of electroconvulsive therapy in bipolar depression

“…However, ECT appears to be equally effective among patients with BDD and MDD for achieving clinical remission. As ECT is significantly underutilized for the treatment of major depression, especially in BDD , our data underscore the potential utility of ECT in the treatment of this patient population .…”

“…The length of episode seems to positively correlate with treatment resistance and poor outcome after ECT, a key point to discourage the use of ECT as a ‘last resource’ option . Despite its well‐known and proven effectiveness, the indication for ECT continues to be strikingly uncommon and many times limited to patients with multiple comorbidities . Although access to ECT is variable, a recently published report suggests that only 1% of patients with treatment‐refractory depression and 0.25% of patients with MDD or BDD receive ECT in the USA, which could be considered a significant underutilization .…”

“…Despite its well‐known and proven effectiveness, the indication for ECT continues to be strikingly uncommon and many times limited to patients with multiple comorbidities . Although access to ECT is variable, a recently published report suggests that only 1% of patients with treatment‐refractory depression and 0.25% of patients with MDD or BDD receive ECT in the USA, which could be considered a significant underutilization . Moreover, the cost‐effectiveness of ECT has been well established in the case of treatment‐refractory depression , and this should also motivate clinicians to consider ECT more frequently as an option for the treatment of patients with BDD.…”

A Physiological Marriage Made in Heaven: Treating and Measuring the Brain Through Stimulation

“…Of the patients with TRD, only about 1% receive electroconvulsive therapy (ECT), which is widely considered the gold standard treatment for TRD . ECT can produce remission of depressive symptoms in 60–75% of patients with depression and remission, or near remission, of suicidality in up to 81% of patients at the completion of the acute ECT course .…”

“…Numerous patients refuse ECT because of these significant adverse cognitive effects. ECT is also negatively stigmatized, contributing to the previously mentioned fact that only about 1% of patients with TRD receive ECT . Nevertheless, ECT was once heralded as a medical breakthrough and has helped the field reorient to the possibility that innovative approaches to brain stimulation may result in therapeutic innovation for neurologic and psychiatric disorders.…”