Electroconvulsive Therapy

Abstract

To the Editor: In the instructive article entitled “Recognition and Management of Anxiety and Depression in Elderly Patients,” which was published in the October 1995 issue of the Mayo Clinic Proceedings (pages 999 to 1006), Martin and associates did not mention the option of electroconvulsive therapy (ECT). ECT has an important role in the treatment of acute depression in elderly adults.1NIH Consensus Development Panel on Depression in Late Life Diagnosis and treatment of depression in late life [consensus conference].JAMA. 1992; 268: 1018-1024Crossref PubMed Scopus (516) Google Scholar In some elderly patients, especially those with severe depression, ECT may be the best choice2Blazer DG Depression in the elderly.Hosp Pract (Off Ed). 1994 Jul; 29: 37-41PubMed Google Scholar because such patients have an increased risk of psychotic depression, which is often more responsive to ECT than to medications.3Blazer D Depression in the elderly.N Engl J Med. 1989; 320: 164-166Crossref PubMed Scopus (234) Google Scholar, 4Sackeim HA Prudic J Devanand DP Kiersky JE Fitzsimons L Moody BJ et al.Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.N Engl J Med. 1993; 328: 839-846Crossref PubMed Scopus (782) Google Scholar ECT is well tolerated by elderly patients with depression. Multiple methods of physiologic monitoring have decreased the occurrence of adverse effects,' and unilateral nondominant electrode placement is associated with less severe cognitive side effects after treatment.” ECT often has fewer side effects than drug therapy,2Blazer DG Depression in the elderly.Hosp Pract (Off Ed). 1994 Jul; 29: 37-41PubMed Google Scholar especially in comparison with the older generation of antidepressants. In addition, it has two advantages over drugs: its rapid onset of action and its effectiveness when drugs have failed.5Crowe RR Electroconvulsive therapy—a current perspective.N Engl J Med. 1984; 311: 163-167Crossref PubMed Scopus (37) Google Scholar The cumulative studies of ECT establish it as a modem medical procedure.6Potter WZ Rudorfer MV Electroconvulsive therapy—a modern medical procedure [editorial].N Engl J Med. 1993; 328: 882-883Crossref PubMed Scopus (50) Google Scholar I believe that no review on the management of depression is complete without mention of this therapeutic option. Electroconvulsive Therapy: In ResponseMayo Clinic ProceedingsVol. 71Issue 4PreviewDr. Gross is entirely correct in his mention of the importance of electroconvulsive therapy (ECT) for severe or unresponsive cases of depression in elderly persons. We did not mention this type of treatment in our article because it was mainly targeted toward primary-care physicians assessing outpatients. ECT for persons of any age would obviously require psychiatric consultation before implementation. As Dr. Gross correctly noted, ECT may be a safe, effective, and, occasionally, lifesaving treatment for severe depression in persons of all ages. Full-Text PDF