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: 2.55). 11/2002; 47(8):734-41.
Source: PubMed


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.

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    • "Advancing age was also seen as a predictor. However, a metaanalysis by Flint and Gagnon (2002) found a positive correlation between ECT efficacy and advancing age. They explained that age is not the cause of postictal confusion; however, it is the age-related neurological conditions (e.g. "
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    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
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    • "L'ECT peut donc être une alternative intéressante. En effet, l'efficacité et l'innocuité de l'ECT dans la dépression du sujet âgé n'est plus à démontrer [22] [23]. De plus, l'ECT est plus efficace que les antidépresseurs chez les sujets âgés [24]. "
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    ABSTRACT: This article is a review of literature on ECT practice in the elderly suffering from dementia. ECT is a safe and effective treatment in elderly demented with major depression and/or behavioral disorder. It is more effective and safer than drug therapy. Somatic side effects are not more numerous than in young adult subjects and cognitive disorders are not worsened. These results are yet to be confirmed by randomized controlled trials in this patient population.
    NPG Neurologie - Psychiatrie - Gériatrie 10/2010; 10(59). DOI:10.1016/j.npg.2010.04.002
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    • "L'ECT peut donc être une alternative intéressante. En effet, l'efficacité et l'innocuité de l'ECT dans la dépression du sujet âgé n'est plus à démontrer [22] [23]. De plus, l'ECT est plus efficace que les antidépresseurs chez les sujets âgés [24]. "

    NPG Neurologie - Psychiatrie - Gériatrie 01/2010; 10:204-214.
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