Is Electroconvulsive Therapy Use Among Young-Old and Old-Old Adults Comparable? A 10-Year Population-Level Analysis of Service Provision

Plakiotis, Christos; George, Kuruvilla; O'Connor, Daniel William

doi:10.1097/yct.0000000000000092

Cited by 4 publications

(3 citation statements)

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“…Although there have been different attitudes towards the merits and disadvantages of electroconvulsive therapy (ECT) (Chung, ; Cong et al ., ; Huang et al ., ), it is still widely used in older patients in many parts of the world (Prudic et al ., ; Chanpattana, ; Plakiotis et al ., ). For example, in a postal survey, patients aged 65 years and above accounted for 38.4% of all ECT recipients in Australia (Chanpattana, ).…”

Section: Introductionmentioning

confidence: 97%

Use of electroconvulsive therapy in older Chinese psychiatric patients

Zhang

Wang

Pan

et al. 2014

Int J Geriat Psychiatry

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Section: Introductionmentioning

confidence: 97%

Use of electroconvulsive therapy in older Chinese psychiatric patients

Zhang

Wang

Pan

et al. 2014

Int J Geriat Psychiatry

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“…German treatment guidelines follow a rather ECT-supportive path but limit the first-line indication for ECT to delusional depression, depressive stupor, schizoaffective psychosis with severe depressive mood, major depression with high suicidality or refusal to eat, and acute life-threatening pernicious catatonia ( Folkerts et al, 2003 ). The medical profession behind the statement has established that “refraining from ECT would mean an ethically unjustifiable restriction of the right of critically ill patients, who are often at risk for suicidal behavior, to get the best possible treatment.” In line with this position, review publications ( Kellner et al, 2020 ) and meta-analyses suggest to advertise ECT progressively to be used in a wider indication even in patients with potential risk profiles as ECT has been proven to be effective and safe during the first trimester of pregnancy ( Calaway et al, 2016 ) in children ( Døssing and Pagsberg, 2021 ) as well as in old-old adults aged 80 years and older ( Plakiotis et al, 2014 ; Kellner et al, 2016 ; McCall et al, 2018 ), and in patients with behavioral and psychological symptoms of dementia ( Swierkosz-Lenart et al, 2019 ).…”

Section: Discussionmentioning

confidence: 97%

Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

Hajak

Hajak²,

Ziegelmayer³

et al. 2021

Front. Psychol.

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Background: Extensive research has reported that electroconvulsive therapy (ECT) can be highly effective in approximately 80% of patients suffering from depression. Its clinical use is mainly limited by historical objections and the concern about unwanted adverse effects (AEs), including serious and potentially life-threatening adverse events (pLTAEs), induced either by ECT or by anesthesia. Objective risk estimation is, therefore, a decisive factor in determining an indication for ECT.Methods: This paper presents a retrospective analysis of 3-year safety protocols and patient files of 157 patients who received a total of 3,106 ECT applications in a psychiatric inpatient setting at a psychiatric community hospital. This patient group comprises 5.3% of inpatients admitted with comparable diagnoses. Adverse events were analyzed from standardized safety protocols and patient files with a focus on pLTAEs.Results: Adverse events were reported for 30 (19.1%) of the 157 participants during 39 (6.1%) of 641 hospital stays. Serious pLTAEs occurred during three electroconvulsive stimulations in three patients, who needed action through the administration of medication or mechanical respiration. No patient suffered permanent damage to health, and no patient died. The incidence of these and other AEs was independent of sex, age, and diagnosis of patients, and anesthesia medication. Minor AEs occurred more often with higher stimulus doses and an increasing number of treatments.Conclusion: The low incidence rate of 0.097% of serious pLTAEs that require medical action may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting. The beneficial risk profile of ECT performed in the standard care of psychiatric hospitals suggests a more generous indication of this treatment method. We recommend that ECT facilities collect individual safety data to allow a reliable judgment of their institutional ECT risk profile.

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“…Data from a recent review of ECT studies conducted worldwide reported that one third of patients treated with ECT in Australia and New Zealand were over 65 years old, and 48-59 % of the patients treated in the USA were over 60 [12]. Moreover, reports on rates of ECT use suggest that older adults receive ECT at a higher rate than the overall population (e.g., 99.88 per 100,000 patients vs 37.85 per 100,000) [13][14][15] and that in fact, the highest rates of ECT use might be among the old-old population (>75-80 years old) [14].…”

Section: Electroconvulsive Therapy (Ect) Ect Use In the Elderlymentioning

confidence: 95%

Neuromodulation Therapies for Geriatric Depression

Gálvez

Alonzo

et al. 2015

Curr Psychiatry Rep

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Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed.

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Is Electroconvulsive Therapy Use Among Young-Old and Old-Old Adults Comparable? A 10-Year Population-Level Analysis of Service Provision

Cited by 4 publications

References 27 publications

Use of electroconvulsive therapy in older Chinese psychiatric patients

Use of electroconvulsive therapy in older Chinese psychiatric patients

Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

Neuromodulation Therapies for Geriatric Depression

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