Electroconvulsive Therapy in the United States: How Often Is It Used?

Abstract

Information on electroconvulsive therapy (ECT) utilization varies widely, and, in general, there is little systematic reporting, particularly in the absence of large and comprehensive medical databases. Most recent attempts to estimate utilization in the United States have necessarily focused on particular regions via survey ( 1 Prudic J. Olfson M. Sackeim H.A. ECT practices in the community. Psychol Med. 2001; 31: 929-934 Crossref PubMed Scopus (76) Google Scholar ) or on jurisdictions that mandate the reporting of ECT utilization ( 2 Scarano V.R. Felthous A.R. Earl T.S. Early TS The state of electroconvulsive therapy in Texas. J Forens Sci. 2000; 45: 1197-1202 PubMed Google Scholar , 3 Kramer B.A. Use of ECT in California, revisited: 1984–1994. J ECT. 1999; 15: 245-251 PubMed Google Scholar ). Furthermore, there have been no utilization studies in the past decade. The most recent attempt to estimate use was made in 1995 ( 4 Hermann R.C. Dorwart R.A. Hoover C.W. Brody J. Variation in ECT use in the United States. Am J Psychiatry. 1995; 152: 869-875 PubMed Google Scholar ). Against this background, Case et al. ( 5 Case B.G. Bertollo D.N. Laska E.M. Price L.H. Siegel C.E. Olfson M. Marcus S.C. Declining use of electroconvulsive therapy in United States general hospitals. Biol Psychiatry. 2013; 73: 119-126 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar ) have used a large national inpatient database to address a highly specific aspect of ECT utilization from 1993 through 2009. The authors clearly state the limitations of their approach: it does not include 50% of psychiatric facilities, and it ignores the increasing use of outpatient ECT. In addition, the authors focused on a specific diagnosis, severe recurrent unipolar major depression, which, even though it is the most common diagnosis associated with ECT treatment in the United States, ignores a variety of other generally accepted psychiatric diagnoses, e.g. bipolar disorder (depressed, manic, and mixed) and schizoaffective and schizophrenic spectrum disorders as well as others ( 6 American Psychiatric AssociationThe Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. 2nd ed. American Psychiatric Association, Washington, DC2001 Google Scholar ). Bipolar depression and schizoaffective depression alone can comprise 20% of patient populations in ECT research studies ( 7 Prudic J. Olfson M. Marcus S. Fuller R. Sackeim H.A. The effectiveness of ECT in community settings. Biol Psychiatry. 2004; 55: 301-322 Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar ), and the frequency of bipolar diagnoses in the context of depression appears to have increased recently ( 8 Yutzy S.H. Woofter C. Abbott C.C. Melhem I.M. Parish B.S. The increasing frequency of mania and bipolar disorder: causes and potential negative impacts. J Nerv Ment Dis. 2012; 200: 380-387 Crossref PubMed Scopus (16) Google Scholar ). Given that these factors, particularly outpatient ECT, may have systematically varied over the time interval of interest, it is not possible to make inferences from the findings by Case et al. ( 5 Case B.G. Bertollo D.N. Laska E.M. Price L.H. Siegel C.E. Olfson M. Marcus S.C. Declining use of electroconvulsive therapy in United States general hospitals. Biol Psychiatry. 2013; 73: 119-126 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar ) as to the utilization rates for overall ECT practice in the United States. Declining Use of Electroconvulsive Therapy in United States General HospitalsBiological PsychiatryVol. 73Issue 2PreviewFalling duration of psychiatric inpatient stays over the past 2 decades and recent recommendations to tighten federal regulation of electroconvulsive therapy (ECT) devices have focused attention on trends in ECT use, but current national data have been unavailable. Full-Text PDF