Effective use of electroconvulsive therapy in late-life depression.

University of Toronto, Geriatric Psychiatry Program, University Health Network, Toronto, Ontario.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.41). 11/2002; 47(8):734-41.
Source: PubMed

ABSTRACT 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. Naturalistic studies have found that 50% of more of patients have a relapse of depression within 6 to 12 months of discontinuing acute ECT.
In recent years, there has been substantial progress in our understanding of the effect of technical factors on the efficacy and cognitive side effects of ECT. When administered in an optimal manner, ECT is a safe, well-tolerated, and effective treatment in older patients. Relapse of depression after response to ECT remains a significant problem, and there is a need for further research into the prediction and prevention of post-ECT relapse.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The current study examined the efficacy of Electroconvulsive Therapy (ECT) as a treatment method for unipolar and bipolar depression using an objective measure through a retrospective chart review. First, this article discusses the history of ECT as well as issues in psychiatric diagnoses. Patients’ progress in this study was measured by the hospital’s psychiatrists as well as through the self-report measure, Clini- cally Useful Depression Scale (CUDOS). The sample consisted of 22 female and 8 male depressed inpa- tients and outpatients. A 2 × 2 mixed ANOVA revealed a significant interaction, showing improvement from pre-treatment to post-treatment in both genders. In post-treatment, female patients showed signifi- cantly more improvement than male patients. This study suggests that ECT results in depression reduction, especially in female patients. In addition, the CUDOS has shown to be a simple and effective self-report measure in assessing progress of depression including complex treatments, such as ECT. Recommenda- tions for future ECT studies include: controlling for comorbidity and medication by obtaining a larger sample size to categorize patients according to medication type and dosage.
    Open Journal of Depression 11/2012; 1(2):9-14. DOI:10.4236/ojd.2012.12002
  • [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Background: It is generally assumed that the elderly patients are more vulnerable to cognitive side effects after electroconvulsive therapy (ECT) than younger depressed patients. The current study aims to evaluate the nature and extent of changes across multiple domains of neurocognitive functioning in a group of elderly depressed patients after ECT. Methods: In this prospective naturalistic study, we included 42 depressed patients aged ≥55 years. Global cognitive function, memory, and executive function were assessed before ECT treatment and within one week (short-term post-ECT) and six months after ECT (long-term post-ECT). Associations between cognitive functioning and electrode placement, total number of treatment sessions, age, and the severity of depression at the time of cognitive measurement were studied. Results: Our data offered no evidence of decline for any of the neurocognitive tests after ECT, given its power to detect the difference. Post-ECT improvement of neurocognitive functioning was statistically significant for the Mini-Mental State Examination, Visual Association Test, 10 Words Verbal Learning Test, and Expanded Mental Control Test. Effect sizes were medium to large. After six months, compared with post-ECT performance, statistically significant improvement was found only for the Trail Making Test-A and the Letter Fluency Test with small to medium effect sizes. Conclusions: In our severely depressed elderly patients, neurocognitive performance improved or did not change after ECT. Patients with poor cognitive function were not able to participate in neuropsychological assessment before ECT started. Consequently these results may not apply to patients with more severe cognitive impairment prior to the start of ECT.
    International Psychogeriatrics 11/2013; 26(2):1-10. DOI:10.1017/S1041610213001932 · 1.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Depression is common in the elderly, particularly in older persons with neurologic illness. Its etiology in this population is incompletely understood and likely to be multifactorial. Identifying depression in elderly patients with neurologic illness can be a challenge, as many of its features resemble symptoms of the underlying neurologic disease or of the aging process itself. Nevertheless, recognition and effective management of depression in this population is vital, since depression is a major source of excess morbidity and since treatment often results in improved quality of life for patients and their caregivers. Assessing for suidicality is a key diagnostic consideration in this population. Antidepressant medications, psychotherapy, and electroconvulsive therapy all can be effective in treating depression in elderly neurologic patients.
    Cleveland Clinic Journal of Medicine 11/2005; 72 Suppl 3:S52-64. DOI:10.3949/ccjm.72.Suppl_3.S52 · 3.37 Impact Factor


Available from