A population-based study confirmed the efficacy of electroconvulsive therapy
Scottish scientists have conducted a population-based study and concluded that electroconvulsive therapy is effective and reasonably safe for a variety of mental illnesses. The paper is being presented at the 32nd European Psychiatric Congress EPA 2024 in Budapest.
Electroconvulsive therapy (ECT) is a treatment method for severe mental disorders in which short electrical impulses are passed through the patient's head under general anesthesia, causing brief (less than two minutes) seizures. It is used for severe and/or psychotic depression, postpartum psychosis, mania, and other severe conditions when medications and psychotherapy have been ineffective. ECT has a rapid and pronounced effect, but is often criticized as a questionable treatment method with potentially dangerous side effects.
To assess the practical results of the method, Julie Langan Martin (Julie Langan Martin) from the University of Glasgow and colleagues analyzed data from the Scottish ECT Audit Network (SEAN) for the years 2009-2019. The final analysis included 4,826 ECT sessions for a variety of indications. In 68.4 percent of them were women, and the average age of the patients was 58.52 years. On average, each received 9.59 sessions with an average dose of 277.75 millicoulombs. Recorded variables included age, gender, Scottish Index of Deprivation (SIMD), ICD-10 diagnosis, mental health status, presence of consent to the intervention, and MADRS depression scale scores. Outcomes were assessed by the CGI-S generalized condition severity index before and after treatment and recorded adverse events.
CGI-S data were available for 2920 ECT sessions. Before treatment, the mean score was 5.03 (95% confidence interval 4.99-5.07), corresponding to severe illness. It was highest for schizophrenia (5.45) and postpartum psychiatric disorders (5.38). After therapy, the mean CGI-S decreased to 2.07 (95 percent confidence interval 2.03-2.11), i.e., borderline healthy. It was lowest in mixed affective states (1.72) and schizoaffective disorder (2.01).
The most common side effects were confusion and cognitive impairment (one third of patients in total). Muscle pain was reported in 12 percent of cases; nausea was reported in 7.2 percent. Cardiovascular complications developed in 2.2 patients. Side effects associated with general anesthesia and prolonged seizures were observed in less than one percent of sessions.
The results support the efficacy and safety of ECT administered to appropriately selected patients with severe mental illness. However, careful monitoring of side effects, especially cognitive effects, is necessary, Martin concluded.
Earlier, Swedish psychiatrists conducted clinical trials involving 186 patients and found that ECT was more effective than ketamine in treating severe depression resistant to therapy with classical antidepressants. Their Danish colleagues described a curious case in which a patient's color blindness symptoms temporarily disappeared after ECT for postpartum depression.