Electroconvulsive Therapy

Nick Zrinyi
May 10, 2016

An overview and summary of electroconvulsive therapy (ECT) in scientific medical literature.

I'd eventually like to get some references in here and clean up the format but for now it will stay as a jumble of study summaries.

Note: Some of them include treatment of pathologies other than depression but I tried to keep it all within the mood disorder realm. There are different techniques i.e. electrode placement, current magnitude, number of treatments, etc so conclusions must be drawn carefully, if at all.

ECT Overview

ECT is used to treat treatment-resistant depression and other mental or social afflictions. After typically being given general anesthesia, current is applied through strategically placed electrodes on the head. The current induces a minute-long seizure. Mechanism of treatment is unknown, but Bocchio-Chiavetto et al., 2006 showed that neuronal growth is stimulated.

No evidence that ECT causes brain damage. Mostly prescribed to women.

A number of mental health associations — including the American Psychiatric Association — have concluded that there is no evidence that ECT causes structural brain damage. A 1999 report by the U.S. Surgeon General states, "The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals"

The Ministry of Health in Canada reported that from 1999 until 2000 in Ontario, women were 71 per cent of those given ECT in provincial psychiatric institutions, and 75 per cent of the total ECT given was given to women.

Successful treatment of 2 people using pulse ECT

Right unilateral ultrabrief-pulse electroconvulsive therapy: The successful treatment of 2 patients in this report suggests that some manic episodes can be rapidly and effectively treated with RUL-UB ECT.

ECT had no effect on mental state, also no adverse effects

The psychiatric patients were examined using mini-mental state examination in terms of the cognitive deficits before ECT as well as 5 and 24 hours after ECT. All the patients completed the trial. There were no reports of adverse effects. In terms of depth of anesthesia, no significant difference was observed. Regarding mini-mental state examination scores, the difference was not statistically significant.

0.43% of adolescent patients received ECT

22 children and adolescents received ECT during the study period (September 2002–September 2012). There were 5047 admissions to the in-patient centre during this period. The frequency of electroconvulsive therapy use per patient was 0.43%. Equal number of boys and girls received electroconvulsive therapy. The average age was 14.18 years (SD 1.33) with youngest patient being 10 years of age.

77% of patients experienced improvements, half of them relapsed but almost all remained somewhat functional

At discharge, 77.3% (17) of the patients were rated as very much improved or much improved and only 22.7% (5) were rated as minimally improved or worsened, as per the Clinical Global Impressions Improvement (CGI-I) Scale. 68.2% (15) of patients were available for follow up during the period of data collection as per the records. Seven of these 15 patients had experienced relapse after their discharge. The most common reasons for relapse were poor medication compliance and academic stressors. The average duration of relapse after ECT was 275.4 days (SD 266.1).

All the patients were independent in activities of daily living. 93.3% (14) were gainfully occupied (going to school/college, working, or were married and taking care of their homes).

51 Adolescent received an average of 9 treatments, 39 were much improved

From April 1991 through November 2013, 51 adolescents (30 female; mean [SD] age, 16.8 [1.6] years) received ECT.

Patients received a mean (SD) of 9.3 (3.5) treatments.

Thirty-nine patients (77%) were much or very much improved based on Clinical Global Impressions-Improvement scale at the end of the acute treatment. Prolonged seizure duration (>120 seconds) was relatively common (63%) but appeared to decrease in older patients.

ECT did not produce executive function deficits in any of the 29 patients

Patients (n = 29), treated with bitemporal ECT, underwent assessment at three time points: baseline, immediately after ECT course and one month later.

The intensity of depression, as assessed by HAMD-21, was significantly reduced over time. The global clinical impression significantly improved, and no general cognitive impairment (measured by MMSE) was observed during the study period.

Our results support the view that ECT does not produce long-lasting EF(executive function) deficits, nor exacerbates the preexisting ones. The improvement of the EF performances during and after the ECT-induced alleviation of mood symptoms in TRD(treatment-resistant depression) is based mostly on the reduction of time needed to plan the problem solution.

In Summary

ECT seems to be more of a last resort option that does tend to fare better than placebo. Note that sedation is typically offered as an option.

I have no conflict of interests to declare. I do not receive funding from any related companies. As always, feel free to contact me if I've made an error, misrepresented data, or if new research on this topic has come to light.

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