ECT may be a good treatment option for severe depression

ECT may be a good treatment option for severe depression

Electroconvulsive therapy, or ECT, may be effective for the treatment of major depression and is as safe as a large new study concludes.

The procedure, once known as electroshock therapy, has a controversial and largely counterproductive history. This was partly due to misrepresentation in popular books and films such as “One Flew Over the Cuckoo’s Nest”, and partly a result of actual problems with early versions of the procedure, which used strong electric currents and no anesthesia. had gone.

Today, ECT is performed under general anesthesia, and the doctor, working with an anesthesiologist and a nurse, applies a weak electric current (usually about 0.8 amps at 120 volts) to the brain for one to six seconds. . This causes seizures inside the brain, but the patient does not experience muscle contractions due to anesthesia. Seizures cause changes in the brain that relieve symptoms of depression and some other mental illnesses. Typically, doctors administer a series of ECT treatments over a few days or weeks.

The only painful part of the procedure is the insertion of an intravenous line prior to anesthesia. Later side effects may occur, including temporary memory loss, confusion or temporary headache, and muscle pain. Doctors debate whether ECT can cause long-term memory problems different from memory problems that can be caused by depression itself.

For this new study, published in Lancet Psychiatry, Canadian researchers used records from 10,016 adults whose depression was so severe that they spent three or more days in the hospital. Half of them had received ECT, while the other half were treated with drugs and psychotherapy. Their average age was 57 years, and about two-thirds were female. The researchers tracked how each group performed over the 30 days after being discharged from the hospital.

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The study carefully matched control patients, adjusting for more than 75 factors, including sociodemographic characteristics, drug use, other medical diseases, behavioral and cognitive status, and use of psychiatric and other health services. This exhaustive methodology helped to overcome some of the limitations of previous studies.

ECT did not increase the risk of serious medical problems, including circulatory, respiratory or genital problems that required a hospital stay, or death that did not result from suicide. At 30 days after discharge, 105 ECT patients had a serious medical problem, compared with 135 of the controls, with a statistically insignificant difference. The researchers did not track minor medical problems treated in outpatient settings. Suicide was rare in both groups, but significantly less common in those treated with ECT.

“This is an interesting and well-done study,” said Dr. Professor of Psychiatry at the University of Copenhagen. Martin Balslev Jorgensen, who has published extensively on ECT but was not involved in this study. “Since ECT is surrounded by a lot of negative opinion, we need all the help we can get from real-life research.”

Dr. Jacob P. Feigl, medical director of the ECT program at Duke, who also had no part in the work, said the study may be helpful in talking to people for whom the best treatment is ECT but who are not concerned about complications. afraid. “As a clinician,” he said, “it helps me frame the argument. This is a really important one in the discussion about the risks of doing ECT compared to the risks of not doing it in people with severe depression. element contributes.

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Dr. Jorgensen said this study shows that patients don’t need to worry about medical complications and can focus on the real problems of ECT: that you have to be anesthetized, and that many treatments are needed. You may have some loss of memory in the time leading up to and during ECT.

Dr. Irving M. Professor of Psychiatry and Director of the Brain Stimulation Program at Johns Hopkins. Ratey, who was not involved in the report, said this is “an important, substantial study” that adds to the literature that ECT is safe. “This puts it in a medical context — thousands of patients with no significant medical complications.”

The lead author of the study, Dr. Tyler S. Castor, a brain stimulation fellow at the University of Toronto, agreed that ECT has risks, but, he said, so does major depression, which can lead to serious problems — among them, heart disease, dementia, substance abuse. Consumption and suicide. He said the decision to undergo ECT is a “complicated and serious decision”. “There is hope in this study that it provides important information that will enable patients, their loved ones and their doctors to understand the risks and make decisions.”

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