Abstract
BackgroundRecent electroconvulsive therapy (ECT) efficacy studies of right unilateral (RUL) ECT may not apply to real life clinics with a wide range of patients with major depressive episodes.MethodsThe study included two groups of patients. In addition to a homogeneous group of patients with major depression according to DSM-IV criteria with severity of the major depressive episode > 16 scores on 17-item Hamilton Rating Scale for Depression (HDRS) (Group 1, n = 16), we included a heterogeneous group of patients with less severe major depressive episodes or with a variety of comorbid conditions (Group 2, n = 24). We randomly assigned the patients to an RUL ECT treatment dosed at 5 or 2.5 times seizure threshold with an intent-to-treat design. The outcomes measured blindly were HDRS, number of treatments, and Mini-Mental State Examination (MMSE). The patients were considered to have responded to treatment if the improvement in HDRS score was at least 60% and they had a total score of less than ten.ResultsThe Group 2 patients responded poorer (8% vs. 63%), and had more often simultaneous worsening in their MMSE scores than Group 1 patients. The differences in the outcomes between the two different doses of RUL ECT treatment were not statistically significant.ConclusionsECT effectiveness seems to be lower in real-life heterogeneous patient groups than in homogeneous patient samples used in experimental efficacy trials.
Highlights
Recent electroconvulsive therapy (ECT) efficacy studies of right unilateral (RUL) ECT may not apply to real life clinics with a wide range of patients with major depressive episodes
Of those 21 ECT patients who were rejected, one patient did not give her consent to the study, eight patients received bifrontal (BF) ECT as a part of a preliminary study comparing the effects of BF and RUL ECT, five patients participated in the ongoing magnetoencephalography ECT study, two patients refused to discontinue the antidepressant medication, three patient received outpatient ECT, one patient received bitemporal (BT) ECT for schizophrenia, and one patient BT ECT for catatonia
In Group 1, one RUL 2.5 patient had to discontinue the treatment after seven ECT treatments because of ventricular extrasystolia
Summary
Recent electroconvulsive therapy (ECT) efficacy studies of right unilateral (RUL) ECT may not apply to real life clinics with a wide range of patients with major depressive episodes. A routine use of right unilateral (RUL) electroconvulsive therapy (ECT) with an adequately suprathreshold stimulus dose is encouraged by the latest recommendation of the American Psychiatric Association (APA) Task Force Guidelines for ECT [1]. RUL ECT at a moderate dose (100–200%) above seizure threshold (ST) has been often used as the initial standard treatment based on the previous recommendations [2,3]. High-dose RUL ECT has been shown to be more effective than moderate dose RUL ECT in the treatment of patients with major depression [4,5]. Patients vary considerably in the extent and severity of their cognitive side effects following ECT.
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