Electroconvulsive therapy for older adult patients with major depressive disorder: a systematic review of randomized controlled trials (original) (raw)
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The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2012
Electroconvulsive therapy (ECT) is the most efficacious treatment in severely depressed elderly patients. Relapse and recurrence of geriatric depression after recovery is an important clinical issue, which requires vigorous and safe treatment in the long term. Continuation or maintenance ECT (M-ECT) may play an important role in this respect. In this systematic search, we evaluate the efficacy and safety of M-ECT in preventing depressive relapse in patients age 55 or older. Computer databases were searched for relevant literature published from 1966 until August 2010 with additional references. Twenty-two studies met the search criteria including three randomized clinical trials. M-ECT was studied in nine studies exclusively in the elderly patients. Research on this clinically important topic is sparse. On the basis of available literature, M-ECT is probably as effective as continuation medication in severely depressed elderly patients after a successful course of ECT and is general...
Journal of Affective Disorders, 2010
Background: Several variables have been studied as possible predictors for the efficacy of ECT, results from the few studies assessing the influence of age on the efficacy of ECT were inconsistent. In older patients suffering from severe depression, ECT is often the treatment of choice, therefore, investigating the influence of age on ECT response is considered relevant. Method: At two depression units, 141 patients meeting DSM-IV criteria for major depression and scores of at least 18 on the 17-item Hamilton Rating Scale for Depression (HAM-D) were treated with bilateral ECT, twice weekly. Clinical evaluation of depressive symptoms was performed each week; scores on the HAM-D were obtained 1-3 days prior to ECT and 1-3 days after termination of the ECT course. The primary outcome criterion was defined a priori as the mean change on the HAM-D score. The influence of age on mean change on the HAM-D score was analyzed with multiple linear regression analysis, adjusted for three covariables: center, duration of the index episode and presence of psychotic features. Results: Age as a continuous variable had no significant effect on the efficacy of ECT as measured by mean change on the HAM-D score (SE 0.057, p = 0.84). Limitations: The disproportionate distribution of patients among the three age groups appears to be the major limitation of the present study. Conclusion: This study suggests that the efficacy of ECT in elderly depressed patients is at least equal to that in younger depressed patients.
Fixed High-Dose Electroconvulsive Therapy in the Elderly With Depression
The Journal of ECT, 2006
Objective: To evaluate efficacy and tolerability of unilateral (RUL) and bilateral (BL) electroconvulsive therapy (ECT) in the elderly with depression. Methods: Thirty-nine elderly inpatients with major depression referred to ECT were randomized into RUL or BL ECT, using high, fixed electrical doses. Cognition and depression severity were assessed before, during, and 1 month after treatment. Adverse effects were assessed after each session. Results: Remission rates for RUL ECT (88.2%) and BL ECT (68.2%) were similar (P = 0.25). Reduction rates of depressive symptoms were also similar. There were no serious adverse events. There were more adverse effects in the BL ECT group (P = 0.05). BL ECT showed more short-term cognitive impairment, whereas improvements in neuropsychological scores were seen in both groups. Conclusion: In elderly depressive subjects, high-dose RUL ECT is as effective as BL ECT yet produces less adverse effects and less cognitive impairment.
A Prospective Study of Maintenance Electroconvulsive Therapy in an Elderly Depressed Population
Open Journal of Psychiatry, 2021
Objective: This study was conducted to discern the efficacy of maintenance electroconvulsive therapy (M-ECT) in a population of depressed elderly individuals with treatment-resistant depression. Methodology: Twenty-nine (N = 29) individuals over the age of 65 years of age and older were assigned to a control or treatment group on the basis of their decision to receive M-ECT (treatment group) or to refrain from receiving the treatment (control group). A battery of psychometric tests designed to measure severity of depression, quality of life, and cognition were administered at baseline as well as at 6-month and 1-year intervals. Results: Statistical analysis of the data indicated no significant differences in the efficacy of M-ECT between the control and treatment groups in any of the tests administered during the participation of the study. Conclusion: The results of the study suggest that there is no added benefit for patients administered M-ECT. However, study sample size and availability of alternative treatment regimens for the control group limit generalizability of these findings and warrant further investigation.
2001
As part of a C.O.R.E., multi-site longitudinal study comparing continuation electroconvulsive therapy (ECT) vs. continuation pharmacotherapy, the authors determined the response of 253 patients with major depression to acute-phase, bilateral ECT by use of the 24-item Hamilton Rating Scale for Depression. Remission rates for three age-groups, Ն65 years; 46-64 years; and Յ45 years, were 90 percent, 89.8 percent, and 70 percent, respectively. Age, as a continuous variable, positively influenced response to treatment. Bilateral, dose-titrated ECT is a highly effective acute treatment for major depression, and older age confers a greater likelihood of achieving remission. (Am J Geriatr Psychiatry 2001; 9:382-390)
The journal of ECT, 2013
To evaluate the effectiveness and safety of maintenance electroconvulsive therapy (mECT) in elderly patients with treatment-resistant Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive episode. Seven elderly patients with treatment-resistant major depressive episode were treated with a complete ECT cycle. Thereafter, they received one monthly ECT session as maintenance for 1 year. Response to treatment was defined as at least a 50% drop from baseline on the Hamilton Depression Rating Scale (HamD) and remission as not meeting criteria for major depression, a HamD score of 7 or less, and Clinical Global Impressions-Severity of Illness score of 1. We compared their response with the response of 7 elderly patients with treatment-resistant major depression who were treated with a full cycle of ECT but did not receive mECT (non-mECT). We compared the 2 groups for the number of relapses or recurrences of major depressive episodes after remission was achi...
Effective use of electroconvulsive therapy in late-life depression
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2002
To review literature pertaining to the efficacy, safety, and tolerability of electroconvulsive therapy (ECT) in treating late-life depression. We undertook a literature review with an emphasis on research studies published in the last 10 years. There is a positive association between advancing age and ECT efficacy. Age per se does not necessarily increase the risk of cognitive side effects from ECT, but this risk is increased by age-associated neurological conditions such as Alzheimer's dementia and cerebrovascular disease. With appropriate evaluation and monitoring, ECT can be used safely in patients of very advanced age and in those with serious medical conditions. Several technical factors, including dose of electricity relative to a patient's seizure threshold, position of electrodes, frequency of administration, and total number of treatments, have an impact on the efficacy and cognitive side effects of ECT and need to be taken into account when administering ECT. Natur...
Cureus
The present meta-analysis aimed to assess the impact of electroconvulsive therapy (ECT) in preventing the relapse and recurrence of depression in adults with major depressive disorders. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two authors conducted a systematic search of online databases, such as PubMed, PsycINFO, and EMBASE, using keywords, such as "electroconvulsive therapy," "depressive disorders," and "recurrence." The primary outcome measure was the incidence of relapse and recurrence in adults with major depressive disorder who received ECT alone or in combination with an antidepressant medication compared to those who received antidepressant medication alone. The secondary outcome measure was the change in the Mini-Mental State Examination score from baseline to the end of the trial in both groups. A total of six articles were included in the meta-analysis. The pooled rate of recurrence in the ECT group was 28.4% compared to 30.6% in the antidepressant group, with no significant difference between the two groups (risk ratio (RR) = 0.84, 95% confidence interval (CI) = 0.65-1.10, p = 0.21). However, subgroup analysis showed that the risk of recurrence was significantly lower in patients receiving ECT with antidepressant therapy compared to the antidepressant group alone (RR = 0.65, 95% CI = 0.45-0.93, p = 0.02). On the other hand, when ECT was given alone, the risk was higher in the ECT group compared to the antidepressant group; however, the difference was not statistically significant (RR = 1.17, 95% CI = 0.79-1.75). In conclusion, the results of this meta-analysis suggest that ECT alone or in combination with an antidepressant medication does not significantly impact the incidence of recurrence in adults with major depressive disorder when compared to antidepressant medication alone.