ECT efficacy and treatment course: a systematic review and meta-analysis of twice vs thrice weekly schedules. J Affect Disord

Queensland Centre for Mental Health Research, School of Population Health, University of Queensland, Australia.
Journal of Affective Disorders (Impact Factor: 3.38). 04/2011; 138(1-2):1-8. DOI: 10.1016/j.jad.2011.03.039
Source: PubMed


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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Available from: Fiona J Charlson, Oct 29, 2014
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    • "When it comes to frequency of ECT there is no significant difference between once, twice or thrice a week but the response might be faster for thrice a week. The trend suggests that twice a week might be the best compromise for elective cases and thrice a week for urgent cases [28]. The evidence suggests that higher electric dose relative to the individual seizure threshold is needed for unilateral lead placement compared to bilateral lead placement. "

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    • "Early studies suggested that more frequent administration of ECT may be associated with a more rapid response, but at the cost of greater cognitive impairment (Shapira et al. 1991). A recent review (Charlson et al. 2011) found that ECT given twice weekly had similar efficacy to ECT given three times a week, and twice weekly ECT could result in fewer treatments being required. ECT given only once a week was less effective than ECT given three times a week. "
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