Continuation ECT

The December issue of Biological Psychiatry published an article by a team of German psychiatrists with the title “Cognitive-behavioral therapy as continuation treatment to sustain response after electroconvulsive therapy in depression: a randomized controlled trial”.

The trial looked at what happened to 90 people who were treated for depression with right unilateral ultra-brief pulse ECT. 63 of them were described as having responded to ECT and, of these, 60 continued with the second phase of the trial, receiving either continuation ECT, cognitive-behavioural therapy (CBT), or just drugs. There was one person in the continuation ECT group who didn’t receive drugs, but otherwise they were all taking drugs (antidepressants, antipsychotics, mood stabilisers, etc). The CBT group were judged to have the best outcome. As the abstract says:

“Of 90 MDD patients starting the acute phase, 70% responded and 47% remitted to acute ECT. After 6 months of continuation treatment, significant differences were observed in the three treatment arms with sustained response rates of 77% in the CBT-arm, 40% in the ECT-arm, and 44% in the MED-arm. After 12 months, these differences remained stable with sustained response rates of 65% in the CBT-arm, 28% in the ECT-arm, and 33% in the MED-arm. These results suggest that ultra-brief pulse ECT as a continuation treatment correlates with low sustained response rates.”

What the study shows is that, in this group of patients, ECT did not have the spectacular results sometimes claimed by psychiatrists. For example, River Point Behavioral Health in Florida, USA, tells their patients:

“ECT is an exceptionally effective medical treatment, helping 90% of patients who receive it. Most patients remain well for many months after a treatment course; however, monthly or bimonthly maintenance treatments are also an option to maintain disease remission.”

The reality, as the German research shows, is more nuanced.

Psychiatrists in Sweden meanwhile compared the effect of continuation ECT plus drugs with drugs alone following ECT and concluded:

“The post-ECT relapse rates were substantial in both treatment groups with a statistically significant advantage for combined treatment with pharmacotherapy and continuation ECT. Further studies are needed to define indications for continuation ECT, pharmacotherapy, and their combination.”

There was no group receiving CBT in the Swedish research.

One thing that struck me about the patients in the German trial was the minimal amount of education they had. Their average age was 60 and the average number of years of education was I think about 11. Perhaps years of education are counted differently in Germany, but in the United Kingdom that would not leave room for many people with degrees, etc.

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