Major Depressive Episodes -Electroconvulsive Therapy

Electroconvulsive Therapy: Major Depressive Episodes

Evidence for Acute-Phase Efficacy
It is generally accepted that ECT is the most rapid and effective treatment available for major depressive episodes (Weiner and Coffey 1988). The evidence supporting this conclusion is compelling and includes a sizable number of well-controlled "sham-ECT" studies. In these studies, patients were randomized to receive real ECT or sham-ECT (involving anesthesia but no electrical stimulation), thus providing for rigorous double-blind tests of efficacy (Brandon 1986). The degree of increased efficacy with ECT compared with antidepressant medication has also been considered by meta-analytic studies. Janicak et al. (1985), for example, reported that ECT was 20% more likely to induce a remission than were tricyclic antidepressants (P < .001). In many series, ECT has been associated with a remission rate of 80%-90%, with maximum response typically attained after 2-4 weeks. However, it is now apparent that such rates primarily apply to those with high prognosis for good response to ECT (see below), and that response rates for those with more moderate prognoses may be appreciably lower. In addition, there have not yet been adequate comparisons between ECT and newer antidepressant agents or combined antidepressant and mood-stabilizing medications.

Recent data suggest that ECT is as effective in severe nonmelancholic episodes as it is in episodes that meet the criteria to be classified as melancholic (Sackeim and Rush 1995). Similarly, efficacy appears to be equivalent in depressed patients with unipolar or bipolar mood disorders. Psychotic depression, particularly in the presence of mood-congruent delusions, is believed to be associated with an increased likelihood of success with ECT, compared with nonpsychotic depression (Sobin et al. 1996). However, an adequately controlled comparison of ECT with a combination of antidepressant and antipsychotic medications remains to be carried out in psychotic depression.

Electroconvulsive Therapy Introduction Indications