The Effect of Electroconvulsive Therapy on Suicide Risk in Patients with Mood Disorders (original) (raw)
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A review of electroconvulsive therapy in suicidality
Mental Health Clinician, 2015
IntroductionSuicidal thoughts and behaviors are highly associated with major psychiatric illnesses, including depression, schizophrenia, and substance related disorders.1 Suicide is a major cause of death in individuals with mood disorders, and mortality rates are markedly higher in this patient cohort compared with those without mental illness.2,3 The estimated lifetime rate of suicide in those with schizophrenia, major depressive disorder, and bipolar disorder are 6.0%, 14.6%, and 15.5%, respectively, as compared with 0.72% in the general population.4MethodsA literature search was conducted for empirical evidence of affect of suicidality with electroconvulsive therapy.ResultsAvailable evidence suggests electroconvulsive therapy may reduce the risk of suicide in various patient populations.DiscussionThis review seeks to summarize a selection of the pertinent literature describing electroconvulsive therapy's effects on suicidality.
Electroconvulsive therapy and suicide among the mentally ill in England: A national clinical survey
Psychiatry Research, 2011
We aimed to determine the number and characteristics of psychiatric patients receiving electroconvulsive therapy (ECT) who had subsequently died by suicide. Data were collected on an 8-year (1999-2006) sample of suicide cases in England who had been in recent contact with mental health services. Of 9752 suicides, 71 (1%) were being treated with ECT at the time of death. Although the number of patients who received ECT had fallen substantially over time, the rate of suicide in these individuals showed no clear decrease and averaged 9 deaths per year, or a rate of 10.8 per 10,000 patients treated. These suicide cases were typically older, with high rates of affective disorder and previous self-harm. They were more likely to be an in-patient at the time of death than other suicide cases. Nearly half of the community cases who had received ECT had died within 3 months of discharge. Our results demonstrated that the fall in the use of ECT has not affected suicide rates in patients receiving this treatment. Services appear to acknowledge the high risk of suicide in those receiving ECT. Improvements in care of these severely ill patients may include careful discharge planning and improved observation of in-patients in receipt of ECT.
The use of electroconvulsive therapy (ECT) as a treatment for depression (Atena Editora)
The use of electroconvulsive therapy (ECT) as a treatment for depression (Atena Editora), 2024
Objective: Evaluate how Electroconvulsive Therapy impacts treatment efficacy and quality of life in patients with resistant depression, as well as its safety and adverse effects. Methods: Bibliographic review using the PVO strategy, carried out in the PubMed - MEDLINE database, using the terms “Electroconvulsive Therapy”, “ECT” and “Depression”. Initially covering 1,454 articles, articles were selected between 2019-2024, in English and that addressed the research theme, thus selecting 19 articles. Review: Despite being a treatment surrounded by stigma and doubts from both professionals and patients, the present study was essential to elucidate the real benefits and care linked to ECT. It was found that the treatment is very cost-efficient for controlling patients with severe and refractory depressive episodes, as well as suicidal ideation, even more efficient when compared to drug therapy and psychotherapy. Furthermore, this proposal involves possible adverse effects related to structural changes in the Central Nervous System, as well as symptoms of nausea, amnesia and headache. Final considerations: Despite being associated with adverse effects, mainly temporary changes in the Central Nervous System, the benefits in quality of life justify its use. It is vital that healthcare professionals stay informed and clearly communicate the risks and benefits of ECT while continuing to explore and develop new approaches to treating complex and refractory psychiatric conditions.
All-cause mortality among recipients of electroconvulsive therapy
British Journal of Psychiatry, 2007
BackgroundStudies investigating mortality secondary to electroconvulsive therapy (ECT) are few.AimsTo assess the risk of mortality from natural and unnatural causes among ECT recipients compared with other psychiatric in-patients over a 25-year period.MethodRegister-based cohort study of all in-patients admitted to a psychiatric hospital from 1976 to 2000. Cause-specific mortality was analysed using log–linear Poisson regression.ResultsThere were 783 deceased in-patients who had received ECT compared with 5781 who had not. Patients who had received ECT had a lower overall mortality rate from natural causes (RR=0.82,95% CI 0.74–0.90) but a slightly higher suicide rate (RR=1.20,95% CI 0.99–1.47), especially within the first 7 days after the last ECT treatment (RR=4.82,95% CI 2.12–10.95).ConclusionsFurther investigation of the effect of ECT on physical health and the observed increased suicide rate immediately following treatment are needed, although the last finding is likely to resul...
All-cause mortality among recipients of electroconvulsive therapy: Register-based cohort study
The British Journal of Psychiatry, 2007
Studies investigating mortality secondary to electroconvulsive therapy (ECT) are few. To assess the risk of mortality from natural and unnatural causes among ECT recipients compared with other psychiatric in-patients over a 25-year period. Register-based cohort study of all in-patients admitted to a psychiatric hospital from 1976 to 2000. Cause-specific mortality was analysed using log-linear Poisson regression. There were 783 deceased in-patients who had received ECT compared with 5781 who had not. Patients who had received ECT had a lower overall mortality rate from natural causes (RR=0.82, 95% CI 0.74-0.90) but a slightly higher suicide rate (RR=1.20, 95% CI 0.99-1.47), especially within the first 7 days after the last ECT treatment (RR=4.82, 95% CI 2.12-10.95). Further investigation of the effect of ECT on physical health and the observed increased suicide rate immediately following treatment are needed, although the last finding is likely to result from selection bias.
The effectiveness of electroconvulsive therapy: a literature review
To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group. Methods – PsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT]. Results – These placebo controlled studies show minimal support for effectiveness with either depression or ‘schizophrenia’ during the course of treatment (i.e. only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis. Conclusions – Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified. Declaration of Interest: Neither author has any financial conflicts of interest in relation to his paper. KEY WORDS: ECT, evidence-based medicine, literature review, cost-benefit analysis.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
Introduction: Electroconvulsive Therapy (ECT) is one of the neurobiological therapies available for the treatment of various psychiatric disorders especially those resistant to pharmacotherapy or, where a rapid response is needed. Aim: To study the response of patients with different psychiatric disorders to ECT and study the relationship between seizure duration and response. Materials and Methods: It was a longitudinal study where a total of 40 patients were studied. Patients aged ≥12 years, who were resistant to pharmacotherapy or, having conditions where rapid response was warranted like suicidality or catatonia were included in our study as cases. A written informed consent was taken from all patients or their caretakers wherever necessary. Scales for assessment of various disorders were applied before and after treatment. Results: Majority of the patients 37.5% were in the age-group of 38-47 years followed by 22.5% in 28-37 years. Only 5% of patients were aged >60 years. Males were slightly higher in number as compared to females (21:19). Affective disorders formed the major group of the patients (75%) followed by schizophrenia (10%), obsessive compulsive disorder (10%) and mental retardation (5%). Overall, 75% of patients showed >50% response to ECT with maximum response seen in affective disorders. No significant relation was seen between seizure duration and response to ECT. Conclusion: ECT is very effective for treating various psychiatric disorders especially affective disorders. ECT is life saving in conditions like catatonia and suicidality.
Evidence-Based Electroconvulsive Therapy for Major Depression Disorder
Scientia Psychiatrica, 2020
Electroconvulsive Therapy (ECT) is a treatment that steals medical attention and the public. Memory disturbance after ECT is a special consideration for the Food and Drugs Administration (FDA) of the United States to classify ECT, whether it belongs to class III (high risk). Psychiatrists or anesthesiologists (who are experienced with ECT) tend to change this classification, while neurologists, psychologists, biostatistics experts, and public representatives agree to maintain ECT status in class III. Contrary to unexpected effects, ECT can induce a transition in severe melancholic patients and suicide to normal functioning humans, after other treatments have failed. With the aim of balancing effectiveness and safety, this paper provides modern evidence of the benefits and risks of ECT.
Electroconvulsive Therapy Use among Depressive Inpatients : Position Statement
Middle East Journal of Nursing, 2016
Introduction: Major Depressive Disorder is one of the most common mental health problems around the world; while Electroconvulsive Therapy is one of the most common methods for treating the disorder; it has a correlated effect over patients with depression. Purpose: The purpose of this paper is to provide a position statement by the current author about using ECT treatment modalities among major depressive patients, especially those who are unresponsive to psychotropic drugs and psychotherapies. Methods: Search strategies included database of Pub Med, Google Scholar, and American Psychiatric Association; they provided many studies about the current topic using some words such as Depression, Electroconvulsive Therapy, Unresponsive, Benefits and Risks. Results: The current (as position statement) author supports the use of Electroconvulsive Therapy among major depressive patients especially those who are treatment resistant to other treatment modalities to enhance psychiatric symptoms and illness relief. Conclusion: Electroconvulsive therapy is considered an effective treatment modality of patients with major depression especially with severe cases and unresponsive to other treatments modalities. Although it has side effects such as being as life threatening for very strict cases, that can be prevented by holistic medical assessment and care.
The Journal of ECT, 2021
Background: Preliminary data suggest that Focal Electrically-Administered Seizure Therapy (FEAST) has antidepressant effects and less adverse cognitive effects than traditional forms of ECT. This study compared the impact of FEAST and ultrabrief pulse, right unilateral (UB-RUL) ECT on suicidal ideation. Methods: At two sites, patients in a major depressive episode were treated openly with FEAST or UB-RUL ECT, depending on their preference. The primary outcome measure was scores on the Scale for Suicide Ideation (SSI). Scores on the suicide item of the Hamilton Rating Scale for Depression (HRSD-SI) provided a secondary outcome measure Results: Thirty-nine patients were included in the intent-to-treat sample (FEAST N=20; UB RUL ECT N=19). Scores on both the SSI and HRSD-SI were equivalently reduced with both interventions. Both responders and non-responders to the interventions showed substantial reductions in SSI and HRSD-SI scores, although the magnitude of improvement was greater among treatment responders.