Justification for use of electroconvulsive therapy to treat depression

Authors of a systematic review in this week's issue of THE LANCET conclude that there is an evidence base to support the use of electroconvulsive therapy (ECT) in the treatment of depression. They conclude that it may be better than drug therapy to treat short-term depressive illness, although ECT use is associated with impaired cognitive ability (especially memory impairment).

ECT has been used in psychiatry since the 1930s, though scepticism remains as to its effectiveness as a treatment for depressive illness. John Geddes from the University of Oxford, UK, and colleagues reviewed 73 randomised trials involving ECT in various comparisons, including ECT compared with 'sham' ECT, ECT compared with drug therapy, bilateral ECT compared with unilateral ECT, and high-dose ECT compared with low-dose ECT. The main assessment outcomes were the decrease in depressive symptoms after therapy, symptom status after 6-month follow-up, effect of therapy on cognitive function, and the effect of therapy on mortality.

Real ECT was significantly more effective than simulated ECT (six trials, 256 patients); treatment with ECT was significantly more effective than pharmacotherapy (18 trials, 1144 participants); bilateral ECT was more effective than unipolar ECT (22 trials, 1408 participants).

The authors comment: "There is a reasonable evidence base for the use of ECT: it does not rest simply on anecdote, habit, and tradition. The trials that have been done reflect concerns that were uppermost at the time. In the 1970s, this concern was efficacy of electroshock per se, more recently it has been dose and site of shock administration. ECT remains an important treatment option for the management of severe depression."

Contact: Professor John R Geddes, Department for Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK;
T) 44-186-522-6480;
F) 44-186-579-3101;
E) john.geddes@psychiatry.oxford.ac.uk

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