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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and Objectives: Electroconvulsive therapy (ECT) is nowadays known as a first line therapy in many certain illness conditions. Despite the fact that psychotic depression and treatment resistant depression are more common in geriatric psychiatry, the use of ECT is not. The aim of our study was to show that ECT can be safely performed even if patients show high comorbidity and are therefore per se at a higher risk for experiencing severe side effects. Methods: We examined 25 ECT treated and severely ill patients of advanced age (mean 66 years) by chart review. Results: Mean age corrected Charlson Comorbidity Index (CCI) was 4.1, mean Cumulative Illness Rating Scale for Geriatrics (CIRS-G) 10.5. Generally, ECT- related complications were rated as mild and short termed, 14 patients showed no complications at all. Complications did not correlate with age or comorbidity. Post hoc, we noted a significant advantage for the use of propofol or etomidate compared with thiopental as narcotic agents. Conclusions: Under optimized somatic treatment conditions ECT can be performed safely in comorbid patients of advanced age. However, a risk/benefit analysis should always be performed individually.
    European Journal of Psychiatry 12/2007; 21(4):237-247. · 0.46 Impact Factor
  • [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; · 1.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Geriatric depression is associated with increased mortality because of suicide and decreases in functional and physical health. Many elders' depression is resistant to psychotherapy and medication and can become chronic. Electroconvulsive therapy (ECT) is increasingly used in the treatment of medication-resistant or life-threatening geriatric depression. Neuromodulation therapies (subconvulsive, focal, or subconvulsive and focal) are alternatives for the management of treatment-resistant depression in the elderly. Therapies that combine both strategies could be safer but may not be as effective as ECT. This review covers the evidence on the safety and efficacy of ECT and the neuromodulation therapies in geriatric depression.
    The Psychiatric clinics of North America 12/2013; 36(4):607-630. · 1.87 Impact Factor


Available from