The Northwick Park Electroconvulsive Therapy Trial

Johnstone, E. C.; Lawler, P.G.; Stevens, Marilyn; Deakin, J.F.W.; Frith, C. D.; McPherson, Klim; Crow, Timothy J.

doi:10.1016/s0140-6736(80)92393-4

Cited by 201 publications

(87 citation statements)

References 15 publications

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“…Their 14 patients with delusional unipolar depression were 5.3 times as likely to complete suicide as their unipolar depressed patients without delusions. Patients with psychotic depression respond better and more rapidly to real rather than sham ECT (30,31). They also respond more rapidly and better than nonpsychotic depressed patients to ECT (19,32).…”

Section: Discussionmentioning

confidence: 96%

Relief of Expressed Suicidal Intent by ECT: A Consortium for Research in ECT Study

Kellner¹,

Fink²,

Knapp³

et al. 2005

AJP

262

164

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Objective-This study assessed the incidence, severity, and course of expressed suicidal intent in depressed patients who were treated with ECT. The data are from the first phase of an ongoing, collaborative multicenter study, the overall aim of which was to compare continuation ECT with pharmacotherapy in the prevention of relapse after a successful course of ECT.Method-Suicidal intent, as expressed by patients during an interview, was scored at baseline and before each ECT session with item 3 on the 24-item Hamilton Depression Rating Scale in 444 patients with unipolar depression.Results-One hundred thirty-one patients (29.5%) reported suicidal thoughts and acts (score of 3 or 4) at baseline. Scores decreased to 0 after 1 week (three ECT sessions) in 38.2% of the patients, after 2 weeks (six ECT sessions) in 61.1%, and in 80.9% at the end of the course of treatment.Conclusions-Expressed suicidal intent in depressed patients was rapidly relieved with ECT. Evidence-based treatment algorithms for major depressive mood disorders should include dichotomization according to suicide risk, as assessed by interview. For patients at risk, ECT should be considered earlier than at its conventional "last resort" position.Suicide and suicide attempts are risks of the major psychiatric illnesses, with mortality rates markedly higher than for the general population (1). A lifetime risk of 15% for suicide was the conclusion of a meta-analysis of hospitalized patients by Guze and Robins (2). A reanalysis of studies of suicide in affective illness in three groups of patients-outpatients, inpatients, and suicidal patients-found a risk of those ever hospitalized of 8.6% (3). Other studies confirmed the risk of suicide to be particularly high in hospitalized depressed patients (4-6). Profound hopelessness, hypochondriacal ruminations or delusions, and thoughts of suicide or self-harm during depression predict future suicide (7).Antidepressant medications are the principal agents used to treat affective disorders today. Their impact on suicide risk is not well defined, however, and they are generally viewed as less effective than ECT in relieving depression and suicidal thoughts. Hordern et al. (8) reported no suicides at the 6-month follow-up in 34 women treated with ECT but found two in the 84 patients treated with antidepressants (2.4%). Avery and Winokur (9) suicidal behavior in the 6 months following the treatment of depression in 519 patients. Suicide attempts were recorded in 0.8% of the ECT patients compared to 4.2% of those who had received "adequate" and 7% "inadequate" antidepressant medication treatment. Khan et al. (10) found antidepressant drugs to be no more effective than placebo in reducing suicide rates in seriously ill depressed patients.The experience with ECT is also unclear. A comparison of the frequency of suicides in different decades found decreased rates when ECT was the dominant treatment for mental illness (11). An examination of the records of 1,397 completed suicides in Finland within a 12-m...

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Section: Discussionmentioning

confidence: 96%

Relief of Expressed Suicidal Intent by ECT: A Consortium for Research in ECT Study

Kellner¹,

Fink²,

Knapp³

et al. 2005

AJP

262

164

View full text Add to dashboard Cite

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“…16,17 When the MeSH were associated with specific nosologies (depression, mania and schizophrenia), 185 RCT about depression, 19 about mania and 22 about schizophrenia were found. Of these, we selected only those that evaluated efficacy, indications and/or profile of ECT adverse effects.…”

Section: Indicationsmentioning

confidence: 99%

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica

Moser

Lobato

Belmonte-de-Abreu

2005

Rev. psiquiatr. Rio Gd. Sul

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A eletroconvulsoterapia (ECT) consiste em tratamento biológico ainda não amplamente utilizado na prática psiquiátrica, devido aos inúmeros fatores que contribuem para uma resistência acerca do método. Objetivando sustentar, com embasamento científico, o emprego da ECT, agregamos evidências de sua eficácia, indicações, contra-indicações e efeitos adversos, advindas dos principais ensaios clínicos randomizados e meta-análises disponíveis na literatura médica atual sobre o tema (PubMed/MEDLINE, Cochrane).

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“…For the latter method the pivotal therapeutic role of the induced generalized seizure has been well established (e.g. Johnstone et al, 1980;Brandon et al, 1984;Gregory et al, 1985), but possibly other mechanisms may also play a substantial role which have not been explored in detail. A possible therapeutic effect of TMS may provide some insight into these mechanisms and include the clinical advantage of being without side-effects or risks, like the one of anaesthesia.…”

Section: -622u93/05036145~0750mentioning

confidence: 99%

Application of transcranial magnetic stimulation in treatment of drug‐resistant major depression—a report of two cases

Höflich

Kasper

Hufnagel

et al. 1993

Human Psychopharmacology

210

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We report the cases of two drug-resistant major depressed psychotic patients, who were treated with 10 sessions of transcranial magnetic stimulations (TMS) and afterwards with 10 sessions of electroconvulsive therapy (ECT) without changing the concomitant neuroleptic and antidepressive medication. TMS did not exert a therapeutic effect in one patient and only a slight one in the other. However, there was a clear beneficial effect for ECT in the patient not responding to TMS and a slight therapeutic effect in the other. In summary, there was no clear-cut evidence for effectiveness of TMS as a treatment for patients with psychotic, therapy resistant depression.However, since there was a slight therapeutic effect of TMS in one patient it seems worthwhile to explore its therapeutic efficacy in a larger group of depressed patients.KEY wow-Transcranial magnetic stimulation, electroconvulsive therapy, drug-resistant major depression.

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The Northwick Park Electroconvulsive Therapy Trial

Cited by 201 publications

References 15 publications

Relief of Expressed Suicidal Intent by ECT: A Consortium for Research in ECT Study

Relief of Expressed Suicidal Intent by ECT: A Consortium for Research in ECT Study

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica

Application of transcranial magnetic stimulation in treatment of drug‐resistant major depression—a report of two cases

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