Abstract

Electroconvulsive therapy (ECT) remains the most effective therapy in treatment-resistant depression. However, the safety of ECT has been consistently questioned, particularly among elderly patients. We assessed the efficacy and safety of ECT in patients before and after 65 years old. The study was conducted between 2015 and 2018 and included 91 patients (61 under and 29 over 65 years old) with major depression undergoing ECT. The Hamilton Depression Rating Scale was used to evaluate efficacy. Cognitive functions were assessed using: MMSE, RAVLT, Trail Making Test, Stroop Test and Autobiographical Memory Interview-Short Form. ECT was more effective in older patients as compared to younger (p < 0.001). No serious adverse events were observed in either group. Increased blood pressure and arrhythmias were more common in the older compared to the younger group (p = 0.044 and p = 0.047, respectively), while disturbances of consciousness did not differ between groups (p = 0.820). Most of the cognitive functions remained unchanged compared to baseline, whereas the outcomes of MMSE, RAVLT and Stroop tests showed greater improvements in the older compared to the younger group (all p < 0.05). The decline in the retrieval consistency of autobiographical memory was more pronounced in the younger group (p = 0.024). ECT is a highly effective, safe and well-tolerated method of treating depression regardless of age.

Highlights

  • Published: 18 June 2021The chronic and recurrent nature of mood disorders, as well as the often coexisting drug resistance, are current major medical challenges

  • A significant proportion of patients suffering from major depression despite sequential combination or augmentation treatment strategies do not achieve improvement and meet the criteria of treatment-resistant depression (TRD)

  • 65 years old or above with major depression treated with Electroconvulsive therapy (ECT)

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Summary

Introduction

The chronic and recurrent nature of mood disorders, as well as the often coexisting drug resistance, are current major medical challenges. A significant proportion of patients suffering from major depression despite sequential combination or augmentation treatment strategies do not achieve improvement and meet the criteria of treatment-resistant depression (TRD). Regarding late-life depression, there is a paucity of data on which evidence-based treatment decisions can be made [3]. This problem grows dynamically with the ageing of the society. Various strategies to manage the TRD have been evaluated, such as optimizing the dose of the current antidepressant, combining antidepressants, switching to a different antidepressant or augmenting with other medications (including ketamine and esketamine)

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