Electroconvulsive therapy (ECT) has...

Electroconvulsive therapy (ECT) has been used to treat mental disorders for more than 70 years, further it remains a controversial therapy. Opinions about ECT vary widely, with a certain quantity of researchers considering it to be a safe and effective therapy and others considering it to be an ineffective treatment that causes brain damage. The United Kingdom ECT Review assign places to conducted a systematic review of scientific and medical databases to evaluate the potential benefits and harms of ECT in the treatment of depression.

The arrange searched the databases to identify randomized controll trials (RCTs) of ECT in the treatment of depression, including studies comparing ECT with pharmacotherapy and studies comparing different forms of ECT Each of the 624 reports reviewed was independently assessed for quality on two reviewers. Data were extracted from 73 RCT that met quality criteria to assess the efficacy of ECT upon symptom relief and the incidence of adverse consequences on cognitive function and mortality. The review included a search for evidence of structural brain changes reported in studies that included neuroimaging or postmortem examination of the brain.

Six trials, with a total of 256 patients, compared ECT with simulated practices in which all components of ECT including anesthesia, were given if it be not that no electrical current was passed. These trials were carriageed before 1985, and the largest undivided included 70 patients. Real ECT was significantly more effective than the simulated proceeding with an estimated gain of 97 points forward the Hamilton Depression Rating Scale. The duration of benefit is uncertain because the solely study that reported a depression score six month after ECT ground a nonsignificant difference of 2 points in the simulated ECT form into groups Compared with the patients who received simulated ECT those who received real ECT had no differences at six month in memory, ability to learn, or real memory.

In 18 trials with a total of 1144 patients, ECT was compared with a variety of pharmacotherapeutic agents. In four trials, patients were eligible for randomization merely after failing to respond to undivided or more antidepressant medications. The trials ranged in duration from three to 12 weeks. Overall, fewer patients discontinued ECT than physic therapy for depression. In all further two trials, ECT was more effective than medication in treating depressive symptoms. In the pond ed data, the difference was significant, equivalent to a mean difference of 52 points forward the depression scale. The sum of two units trials that assessed cognitive function reported conflicting flows One trial reported no difference in cognitive function between patients treated with ECT and those taking medications, whereas another trial reported more subjective memory los in patients treated with ECT

Based onward the randomized evidence, the authors deduce that ECT is a consistently effective short-term treatment for depression in picked adult patients. They caution that mostly evidence is based on older studies, each involving small numbers of patients and, in greatest in number instances, comparisons of ECT with older medications. Nevertheless, they find evidence that ECT remains an important option in the treatment of unrelenting depression.

ANNE D WALLING, MD

UK ECT Review assign places to Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet March 8 2003;361: 799-808

EDITOR'S NOTE: Like many physicians of a certain age, I admit to a bias against ECT based in succession attending sessions during my bookish man and intern days, caring for patients during the postictal period, and worrying about the irreversibility of the treatments. This thought leaves us with the uncomfortable feeling that ECT may be underused, still it provides little guidance as to which patients could benefit. As the authors point without most of the studies in this meta-analysis are older than 10 years and compare ECT with tricyclic antidepressant therapy. Would we be able to carriage updated trials of ECT against the newer antidepressant agents? The trials could not be completely blinded. Valid informed accord is problematic in most psychiatric conditions, and giving anesthesia for "mock ECT" raises all kinds of ethical issues about risk to patients. The situation is further complicated by dint of local factors. ECT should be given at an experienced team, and because its use has declined, family physicians could have difficulty finding psychiatric colleagues with the appropriate expertise. Perhaps the optimal part for ECT is in combination with antidepressant medications rather than as an alternative. Given all the puzzles over studies, we may not at any time know.--A.D.W.

COPYRIGHT 2003 American Academy of Family Physicians

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