Abstract
Background: Extensive research has reported that electroconvulsive therapy (ECT) can be highly effective in approximately 80% of patients suffering from depression. Its clinical use is mainly limited by historical objections and the concern about unwanted adverse effects (AEs), including serious and potentially life-threatening adverse events (pLTAEs), induced either by ECT or by anesthesia. Objective risk estimation is, therefore, a decisive factor in determining an indication for ECT.Methods: This paper presents a retrospective analysis of 3-year safety protocols and patient files of 157 patients who received a total of 3,106 ECT applications in a psychiatric inpatient setting at a psychiatric community hospital. This patient group comprises 5.3% of inpatients admitted with comparable diagnoses. Adverse events were analyzed from standardized safety protocols and patient files with a focus on pLTAEs.Results: Adverse events were reported for 30 (19.1%) of the 157 participants during 39 (6.1%) of 641 hospital stays. Serious pLTAEs occurred during three electroconvulsive stimulations in three patients, who needed action through the administration of medication or mechanical respiration. No patient suffered permanent damage to health, and no patient died. The incidence of these and other AEs was independent of sex, age, and diagnosis of patients, and anesthesia medication. Minor AEs occurred more often with higher stimulus doses and an increasing number of treatments.Conclusion: The low incidence rate of 0.097% of serious pLTAEs that require medical action may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting. The beneficial risk profile of ECT performed in the standard care of psychiatric hospitals suggests a more generous indication of this treatment method. We recommend that ECT facilities collect individual safety data to allow a reliable judgment of their institutional ECT risk profile.
Highlights
World Health Organization studies have highlighted psychiatric disorders to be a leading cause of human disability worldwide (World Health Organization [WHO], 2021)
The largest proportion of this sample had a main diagnosis of a recurrent major depressive disorder (MDD) (F33.x, 59.9%), 7.0% were suffering from a single episode of MDD (F32.x), 12.1% were suffering from bipolar disorder (F31.x), 10.8% from schizoaffective disorders (F25.x), 9.6% from schizophrenia (F20.x), and one participant from an unspecified mental disorder due to brain damage and dysfunction and to physical disease (F06.9)
A population-based cohort study in Canada found a total medical event rate of 9.1, respectively, 16.8 per 10,000 electroconvulsive therapy (ECT), with falls and pneumonia to be the most common events (Blumberger et al, 2017). These data and an extremely low incidence rate of 0.097%, equivalent to approximately one in 1,000 treatments of potentially life-threatening adverse events (pLTAEs) that required immediate medical action in the data set reported here may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting
Summary
World Health Organization studies have highlighted psychiatric disorders to be a leading cause of human disability worldwide (World Health Organization [WHO], 2021). A wide armamentarium of treatment options suggests psychiatric disorders to be well-treatable diseases. Treatment techniques range from a variety of psychotherapies and psychotropic medications to behavioral, physical, and sociotherapeutic approaches to neurophysiological procedures. Acute and severe episodes of schizophrenia, major depressive disorder (MDD), and bipolar depression are treatment resistant (Fekadu et al, 2009; Fornaro et al, 2020; Campana et al, 2021), and a delayed response to medication and psychotherapy remain major issues to treatment. Modern psychiatry has opened up to invasive and highly technical treatment options. The latter include techniques of neurostimulation, with electroconvulsive therapy (ECT) being the oldest among these and all other biological treatments introduced in psychiatry (Kaliora et al, 2018). A decisive factor in determining an indication for ECT
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