Abstract
The purpose of the study was to evaluate the current clinical practice of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation in German psychiatry. Case-based data (> 1.000.000 cases) were collected according to §21 of the German hospital remuneration law from January 2015 to December 2017. The study cohort comprises approximately 35–40% of the annual psychiatric cases and hospitals in Germany. Frequency of ECT and rTMS cases were investigated considering main diagnoses according to ICD-10 and treatment settings (inpatient vs. day-care). ECT cases with short-term hospitalization (≤ 4 days) were supposed to be maintenance ECT cases. A linear regression analysis was conducted to estimate trends in the use of ECT and rTMS. Different groups were compared using Chi-square tests. ECT and rTMS cases appear to increase in total during the observation period possibly due to facilities newly introducing ECT and rTMS but also to increased frequency of treatments. Both treatments were rarely performed in day-care settings (0.89% and 11.25%). ECT was performed in 1.72% of all cases with affective disorders and in 1.48% with major depressions, respectively. Age ≥ 65 years, females, severe and psychotic depression were significantly associated with a higher rate of ECT cases. > 40% of all ECT cases were possibly maintenance ECT cases. Only 0.60% of these were performed in day- care settings. rTMS was primarily performed in major depression (86,7% of all rTMS cases). This study suggests a growing demand for ECT and rTMS. Nevertheless, the use of ECT is still low compared to the high prevalence of treatment resistant depression. The use of rTMS is even lower and seems to be restricted to specialized institutions. Maintenance ECT is frequently carried out in an inpatient setting. Limitations of this study are the case- and group-based analysis, missing data on outpatient services and treatment sessions per case. Therefore, the database is not necessarily representative for the entire German healthcare system. Further studies are needed to verify the presented findings and should address the feasibility of ambulatory and day-care ECT services.
Highlights
Two noninvasive stimulation methods, rTMS and ECT, are effective therapeutic options for diverse psychiatric disorders, i.e. unipolar and bipolar depression [1,2,3,4,5] and psychotic disorders [6, 7]
ECT is still suffering from low acceptance compared with less invasive treatment options for psychiatric diseases [18]. rTMS has been approved for major depression [19] and recently for obsessive compulsive disorder [20]
We found that ECT and rTMS are performed in inpatient and day- care settings in the German mental healthcare system
Summary
RTMS (repetitive transcranial magnetic stimulation) and ECT (electroconvulsive therapy), are effective therapeutic options for diverse psychiatric disorders, i.e. unipolar and bipolar depression [1,2,3,4,5] and psychotic disorders [6, 7]. An evidence-based guideline on the use of a third technique, transcranial direct current stimulation, was published, which induces neuroplasticity by a transcranial electrical stimulation at subthreshold intensities [11,12,13,14]. ECT is considered as the most effective treatment for severe major depression and is superior to the effects of antidepressant. ECT seems to be superior to rTMS, especially considering psychotic depression, and has proved high efficacy in the elderly [15,16,17]. Since rTMS is not generally eligible for reimbursement in Germany, patients often have to pay for rTMS
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