In a recent article in the Journal of ECT, psychiatrists from the Sussex Partnership NHS Foundation Trust looked at relapse rates after electroconvulsive therapy (L. Atiku et al. Improving relapse prevention after successful electroconvulsive therapy for patients with severe depression: completed audit cycle involving 102 full electroconvulsive therapy courses in West Sussex, United Kingdom.) They had noticed that a lot of the people who were having ECT at the clinic in Worthing were coming back for further courses, having relapsed quite soon after treatment, and decided to look at whether relapse rates varied according to what drug treatment the patients received during and after ECT. This was a survey (or audit, as the authors called it) not a controlled study, so no definite conclusions can be drawn, but it revealed a high rate of relapse.
The first survey looked at patients treated with ECT between March 2007 and January 2009. There were 71 courses of ECT, but only 51 were included in the survey (for 10 people notes were not available, 7 had a diagnosis other than depression, two died and one was receiving maintenance treatment with ECT). People over the age of 65 accounted for 38 of the 51 people in the survey; 34 of the 51 were women. After six months 60 per cent of them had relapsed, with relapse being defined as hospital admission or major medication change. All 51 people were taking antidepressants during and after ECT and they were divided into four groups according to whether they were taking antidepressants alone, antidepressants with antipsychotics (the most popular choice of referring psychiatrists), antidepressants with a mood stabiliser, or antidepressants with lithium.
It was the antidepressant with antipsychotic or with mood stabiliser group that did worst, with an 80 per cent relapse rate, the antidepressant alone group had a 60 per cent relapse rate while the antidepressant with lithium group had a much lower relapse rate at 18 per cent. The authors made these results known to referring psychiatrists but it didn’t seem to make any difference to prescribing practice. The second survey, of people receiving ECT between September 2009 and October 2010, revealed fairly similar results. This time patients were more evenly divided between over and under 65 year olds; 80 per cent were women.
The high relapse rates following ECT are not mentioned on Sussex Partnership’s website where it says:
“While some people can experience temporary memory loss as a result of having it, it’s very safe and effective for those people with mental illness whose symptoms aren’t responding to other forms of treatment.”
Has the word “temporary” been misplaced?