ECT efficacy and treatment course: a systematic review and meta-analysis of twice vs thrice weekly schedules.
ABSTRACT Electroconvulsive therapy (ECT) guidelines, across various regulatory bodies, lack consensus as to the optimal frequency of treatment for individual patients. Some authors postulate that twice weekly ECT may have a similar efficacy to thrice weekly, and may have a lower risk of adverse cognitive outcomes. We did a systematic review and a meta-analysis to assess the strength of associations between ECT frequency and depression scores, duration of treatment, number of ECTs, and remission rates.
We searched on Medline, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (to December 2009), and searched reports to identify comparative studies of frequency of ECT. We did both random-effects (RE) and quality effect (QE) meta-analyses to determine the risk of various outcomes associated with lesser frequency as compared to the thrice weekly frequency.
We analysed 8 datasets (7 articles), including 214 subjects. Twice-weekly frequency of ECT was associated with a similar change in depression score (QE model SMD -0.11 [-0.55-0.33] and RE model SMD -0.17 [-0.77-0.43]) as compared to thrice weekly ECT. The number of real ECT's trended towards fewer in the twice weekly group. There was a statistically significant longer duration of treatment with a twice weekly protocol (QE model 6.48 days [4.99-7.97] and RE model 4.78 days [0.74-8.82]). There was a statistically significant greater efficacy for thrice weekly ECT compared to once weekly ECT (QE model SMD 1.25 [-0.62-1.9] and RE model SMD 1.31 [0.6-2.02]).
Twice weekly ECT is associated with similar efficacy to thrice weekly ECT, may require fewer treatments and may be associated with longer treatment duration when compared to thrice weekly. These epidemiological observations support the routine use of twice weekly ECT in acute courses, though choice of frequency should take into account individual patient factors. These observations have implications for resource utilisation e.g. costs of duration of admission vs cost of provision of ECT, as well as issues of access to inpatient beds and anaesthetist time.
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ABSTRACT: One hundred and three patients treated for endogenous depression with unilateral, non-dominant ECT, half with two, half with four treatments weekly, were examined to determine the effect of the treatment on memory functions. Th first-mentioned group was studied with double-blind technique in connection with an earlier study while the latter group was investigated under open conditions. Tests were made before the first treatment, after the sixth treatment, and after the final treatment (the Wechsler Memory Scale Forms I and II) and at the same times, ratings were made of the depressive state. No significant differences were found between the results of the two groups either with regard to the total results or the sub-test results in WMS. This was true for changes between and the first and the sixth treatment and between the first and the final treatment. On the whole, both groups showed improved results during the course of treatment; a memory reduction to an equal degree in both groups evident before treatment, and thus due to the depression, was eliminated concurrently with the improvement in the depressive condition. With reference to delayed reproduction a comparison made after the sixth treatment showed that the high-frequency treatment group scored significantly higher than the other group. This can only be ascribed to a better therapeutic effect resulting from accelerated treatment. Likewise these improved therapeutic results in the high-frequency treatment group must be responsible for the fact that this group does not show poorer test results than the group treated at the customary frequency-rate in spite of an expected deteriorating effect of accelerated treatment on memory functions and in spite of a larger number of treatments per series in this group. Neither in the higher nor in the lower frequency treatment group were any age-related variations in memory found.Acta Psychiatrica Scandinavica 12/1976; 54(5):336-46. · 4.86 Impact Factor
Article: Meta-analysis in clinical trials.[show abstract] [hide abstract]
ABSTRACT: This paper examines eight published reviews each reporting results from several related trials. Each review pools the results from the relevant trials in order to evaluate the efficacy of a certain treatment for a specified medical condition. These reviews lack consistent assessment of homogeneity of treatment effect before pooling. We discuss a random effects approach to combining evidence from a series of experiments comparing two treatments. This approach incorporates the heterogeneity of effects in the analysis of the overall treatment efficacy. The model can be extended to include relevant covariates which would reduce the heterogeneity and allow for more specific therapeutic recommendations. We suggest a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.Controlled Clinical Trials 10/1986; 7(3):177-88.
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ABSTRACT: The benefits and side effects of electroconvulsive therapy (ECT) given two vs. three times per week were examined in depressed inpatients. Twenty subjects were randomly assigned to one of two treatment conditions (unilateral ECT two or three times weekly). Examiners without knowledge of treatment condition rated depression and psychiatric status and administered tests of memory and visual-motor problem solving; subjects also provided self-ratings of depression. Measures were collected before treatment and 2 and 4 weeks after treatment began. Both schedules of treatment produced significant and equivalent improvements in psychiatric symptomatology, but visual memory impairment was significantly lower in the twice-weekly group.Psychiatry Research 06/1987; 21(1):63-9. · 2.46 Impact Factor