Electroconvulsive therapy efficacy

Electroconvulsive therapy (ECT) is a highly efficacious treatment for MDD. The response rate is about 80% to 90% and even exceeds 50% for patients who have failed pharmacotherapy.16,17 ECT may be particularly beneficial for MDD that is complicated by psychotic features, severe suicidality, refusal to eat, pregnancy, or contraindication/non-response to pharmacotherapy.16,17 ECT is typically a very safe treatment alternative, but various cautions do exist, and the chief side effects are confusion and memory impairment.16... 

Carney S, Cowen P, Geddes G, et al. Efficacy and safety of electroconvulsive therapy in depressive disorders a systematic review and meta-analysis. Lancet 2003 361(9360) 799-808. 

Repetitive TMS, unlike electroconvulsive therapy (ECT), uses sub-convulsive stimuli to treat depression. Compared to ECT, TMS has a potential to target specific brain regions and to stimulate brain areas thought to be primarily involved in depression while sparing areas like the hippocampus, thereby reducing the probability of cognitive side effects. However, the therapeutic efficacy of TMS as a treatment for depression is, unlike ECT, modest. Most TMS studies use high-frequency, fast stimulation (> 10 Hz) over the left dorsolateral prefrontal cortex, an area which has been... 

Electroconvulsive therapy is one of the most efficacious treatments for adults with nonresistant (70% response) and resistant MDD (50% response) (APA, 2000). Because of the invasiveness of this treatment, however, it remains the treatment of choice only for the most severe, incapacitating forms of resistant depression. No studies have been carried out among adolescents, but anecdotal reports have suggested that adolescents with refractory depression may respond to ECT without significant side effects (Rey and Walter, 1997). Approximately 60% of adult patients treated successfully with ECT tend to relapse after 6 months (APA, 2000). Therefore, they must also receive maintenance treatment with antidepressants and sometimes maintenance ECT. There are no reports of use of maintenance ECT in adolescents. 

Electroconvulsive therapy (ECT) is an established and effective treatment of depression and some forms of schizophrenia. ECT is the treatment of choice in several types of depression (W. Z. Potter and Rudorfer 1993), especially severe depression (American Psychiatric Association Task Force on Electroconvulsive Therapy 1990 W. Z. Potter et al. 1991). The mechanism by which ECT exerts its antidepressant effect is still unknown. Studies of pharmacologically as well as of electrically induced convulsions suggest that the convulsion is a necessary condition for ECT s therapeutic effects (Cerletti and Bird 1938 Lerer 1987 Lerer et al. 1984). However, there is no satisfactory explanation for the clinical efficacy of convulsions. 

Evidence on the potential antidepressant efficacy of L-dopa is more voluminous, but also discouraging [Kapur and Mann 1992 Oren et al. 1994). Despite the definite effects of L-dopa on mood, its antidepressant efficacy, given with or without a peripheral decarboxylase inhibitor, is not established even in the subset of patients with psychomotor retardation and low pretreatment CSF HVA who are supposed to be particularly sensitive to its effects. Standard antidepressants or electroconvulsive therapy are the methods of choice in treating depression in patients with Parkinson s disease, in whom L-dopa appears to have limited or no antidepressant efficacy and has been suspected of producing depression [Cummings 1992). Furthermore, pro-... 

The literature regarding the role of electroconvulsive therapy (ECT) in OCD has been conflicting and confusing. Several case reports reported efficacy in individual patients (Mellman and Gorman 1992). In a study of eight patients with OCD who received ECT, only one had a good and sustained antiobsessional response (B. Guttmacher, personal communication, 1993). 

Calev A, Eink M, Petrides G, et al Caffeine pretreatment enhances clinical efficacy and reduces cognitive effects of electroconvulsive therapy. Convulsive Therapy 9 95-100, 1993... 

Ottevanger EA The efficacy of fluvoxamine in patients with severe depression. British Journal of Chnical Research 2 125-132, 1991 Ottosson J Experimental studies of the mode of action of electroconvulsive therapy. 

Sackeim HA, Decina P, Prohovnik 1, et al Dosage, seizure threshold and the antidepressant efficacy of electroconvulsive therapy. Ann N Y Acad Sci 462 398-410, 1986... 

Sackeim HA, Decina P, Kanzler M, et al Effects of electrode placement on the efficacy of titrated, low-dose ECT. Am J Psychiatry 144 1449-1455, 1987a Sackeim HA, Decina P, Prohovnik 1, et al Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments. Arch Gen Psychiatry 44 355-360, 1987b... 

When the results from several studies are converted into similar units, a simple inspection of a graph or table readily reveals which studies have different outcomes from the majority. Such discrepancies can also be examined by a variety of statistical indices. For example, one can calculate a statistical index of homogeneity, remove the most discrepant study, and recalculate, revealing that all but one study is homogenous. If two studies are discrepant, one could remove both and again reexamine the indices of homogeneity, and so on. For an example, we summarize the relative efficacy of unilateral nondominant versus bilateral electrode placement for the administration of electroconvulsive therapy (ECT). Here, 10 studies had one result, and two others a different outcome (see Table 8-10 and Table 8-11, in Chapter 8). 

Sackeim HA, Pmdic J, Devanand DP, et al. Effects of stimulus intensity and electrode placement on efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 1993 328 839-846. 

Electroconvulsive therapy is the most controversial treatment in psychiatry and referred to 45 years of dispute surrounding issues such as efficacy and possible complications. In the opening sentence of the introduction to Abrams s (1988) book, Fink referred to the more than 50 years of controversy surrounding ECT. 

Avery, D., Winokur, G. (1977). The efficacy of electroconvulsive therapy and antidepressants in depression. Biological Psychiatry, 12, 507-523. 

It is hard to show improved efficacy over existing medications, especially since the positive effects of antidepressants take so long to appear. Patients who are severely depressed and unresponsive to antidepressant therapy are still treated by electroconvulsive therapy (ECT). The goal is to find targets whose targeting will provide a fast onset of antidepressant effects and in particular a rapid reduction in the suicide risk. 

Psychopharmacological agents such as antidepressants, antipsychotics (in patients with personality disorders) and lithium (in patients with bipolar disorders) have been shown to be effective in preventing suicidal behavior. The efficacy of electroconvulsive therapy (ECT) is more controversial. Another equally important aspect of the optimal clinical management of suicidal patients is the quality of the doctor-patient relationship. 

Legend 1) Nameofmodaiity) Well-established efficacy ECT MAOl Electroconvulsive therapy Monoamine oxidase inhibitor... 

Legend Name of modality" Name of modality M Name of modality Well-established efficacy Some (less established) efficacy Efficacy not well established APD ECT EGA MDD Antipsychotic drug Electroconvulsive therapy First-generation antipsychotic drug Major depressive disorder... 

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