Benefits of ECT May Outweigh Risks for Patients Hospitalized for Depression

Electroconvulsive therapy (ECT) does not appear to significantly increase the risk of serious medical events in adults who are hospitalized for depression, according to a retrospective cohort study.. Additionally, the study found that ECT may reduce the risk of suicide in these patients.

Kaster and colleagues compared more than 10,000 hospitalization records for adults with depression who received treatment at psychiatric inpatient facilities in Ontario, Canada, for more than three days between April 1, 2007, and February 28, 2017. The researchers examined the number of serious medical events (defined as hospitalization or death) experienced by patients who received ECT during their hospitalization compared with those who did not receive ECT. Specifically, the researchers were interested in serious medical events that occurred within 30 days of the first exposure to ECT or the corresponding index date (for those patients who did not receive ECT).

Patients in the ECT group received a mean number of eight ECT sessions. Of the 5,008 patients in the ECT group, 105 had a serious medical event within 30 days (an incidence of 0.25 per person-year); of the 5,008 patients who did not receive ECT, 135 had a serious medical event within 30 days (an incidence of 0.33 per person-year). The number of nonsuicide deaths was low in both groups, with 11 in the ECT group and 12 in the group that did not receive ECT. Similarly, deaths by suicide were rare in both groups, but significantly lower in the ECT group, the authors noted.

Despite substantial evidence that ECT can help patients with treatment-resistant depression, ECT remains underused, due in part to patients’ concerns over potential side effects of the treatment, for patients to make fully informed decisions regarding electroconvulsive therapy, studies need to assess risk of serious medical events among those with depression who receive electroconvulsive therapy compared with those who receive standard care.

They concluded that among individuals hospitalized with depression, we found no evidence for a clinically significant increased risk for serious medical events with exposure to electroconvulsive therapy, and the risk of suicide was found to be significantly reduced, suggesting the benefits of electroconvulsive therapy for depression outcomes might outweigh its risks in this population.

See the article

Risk of serious medical events in patients with depression treated with electroconvulsive therapy: a propensity score-matched, retrospective cohort study. Kaster TS, Vigod SN,Gomes T, Dutradhar R, Wijeysundera DN, Blumberger DM.Lanset Psychiatry2021;8(8): 686-695/12 :2021DOI:https://doi.org/10.1016/S2215-0366(21)00168-1.

 

For related information

Barriers to the Implementation of Electroconvulsive Therapy (ECT): Results From a Nationwide Survey of ECT Practitioners. Wilkinson ST, Kitay NM,Harper A,  Rhee TG, Sint K, Ghosh A,  Lopez MO, Saenz S,Jack Tsai J. Psychiatr Services 2921, https://doi.org/10.1176/appi.ps.202000387.

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