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.
    Full-text · Article · Nov 2012 · Open Journal of Depression
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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: Cette revue traite de la pratique de l’électroconvulsivothérapie (ECT) chez les sujets âgés souffrant de pathologie démentielle. L’ECT est un traitement sûr et efficace chez le sujet âgé dément avec épisode dépressif majeur et/ou trouble du comportement. Elle s’avère plus efficace et sûre que la pharmacothérapie. Les effets indésirables somatiques ne sont pas plus nombreux que chez les sujets adultes jeunes et les troubles cognitifs ne sont pas aggravés. Ces résultats restent cependant à confirmer par des études contrôlées et randomisées dans cette population de patients jusqu’à ce jour inexistantes.
    Full-text · Article · Oct 2010 · NPG Neurologie - Psychiatrie - Gériatrie
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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]. "

    Full-text · Article · Jan 2010 · NPG Neurologie - Psychiatrie - Gériatrie
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