Older patients who receive electroconvulsive therapy (ECT) for treatment of mood disorders have lower risk of mortality and greater protection against short-term risk of suicide, according to a Yale study.
The observational study, published in the American Journal of Psychiatry, involved 41,620 inpatients whose average age was 75. Approximately one-quarter of the patients were treated with ECT. Compared with the control group, patients who received ECT had lower rates of death from all causes for up to one year after they were discharged from the hospital.
ECT treatment also provided short-term protection against suicide in the first months following treatment, but this waned over time, according to the study. The authors say the findings support greater consideration of using ECT for inpatients with mood disorders at short-term risk of suicide.
“I think one of the most striking things from our study was the strong association of ECT and a reduction in mortality among older adults,” said Samuel Wilkinson, MD, assistant professor of psychiatry and the study’s senior author. “This had been shown by prior research, but one of the interesting things was how the individuals receiving sub-therapeutic ECT had an almost identical risk of mortality as those who did not receive ECT for the first three months following hospitalization.”
Patients treated with ECT receive a brief electrical stimulation of the brain while under anesthesia. It is considered safe and effective and is generally administered to patients who do not respond to traditional antidepressants.
At Yale, the service is provided at Yale New Haven Psychiatric Hospital (YNHPH), where specially trained treatment teams administer ECT to patients diagnosed with severe depression and other mental disorders, including bipolar disorder or schizoaffective disorder.
ECT is available on both an inpatient and outpatient basis at YNHPH and is administered at therapeutic levels as opposed to subtherapeutic – levels lower than prescribed – which the Yale study shows does not meaningfully reduce mortality or suicide risk.
Other authors on the study were Taeho Greg Rhee, PhD; Kyaw Sint, PhD; Mark Olfson, MD, MPH; Tobias Gerhard, PhD; and Susan H. Busch, PhD.
Submitted by Christopher Gardner on January 18, 2022
FAQs
Mortality associated with individual ECT treatments was 3.08 per 10 000 treatments over the first 7 days after treatment.
What are the risks of ECT in the elderly? ›
Also, patients with vascular depression may be at increased risk for confusion or transient cognitive worsening post-ECT. Patients with epilepsy may be at slightly increased risk for prolonged or spontaneous seizures during ECT.
What are the long-term side effects of ECT? ›
Some people describe experiencing long-lasting or permanent memory loss. For example, losing personal memories or forgetting information. This can be a very distressing experience. Some people also experience a loss of interest in things or have difficulty concentrating.
What are the pros and cons of ECT? ›
The Pros & Cons Of ECT
First and foremost, the treatment requires sedation, making recovery complex and much longer. Second, ECT has a higher chance to cause serious side effects for some individuals, including memory loss, which can deter potential patients. Pros of ECT: Safer today than previous ECT treatments.
Does ECT reduce life expectancy? ›
Electroconvulsive therapy (ECT) is used to treat severe psychiatric disorders and is associated with reduced risk of suicide and all-cause mortality in patients with severe depression.
Does ECT make dementia worse? ›
In this study, patients exhibited improvement in neuropsychiatric functioning a week following a course of ECT and an improvement in agitation 8 weeks following ECT. There was no discernible worsening in cognitive functioning or dementia symptoms.
What is the most serious complication of ECT? ›
ECT treatment has been associated with temporary memory loss and temporary difficulty learning. Some people have trouble remembering events that occurred in the weeks before the treatment or earlier.
What is the most persistent effect of ECT? ›
The most persistent adverse effect is retrograde amnesia. Shortly after ECT, most patients have gaps in their memory for events that occurred close in time to the course of ECT, but the amnesia may extend back several months or years.
Can ECT make it worse? ›
ECT has been described as a mood stabilizer, with remission rates of 65.3% and 88.0% for bipolar depression and treatment-resistant mania, respectively. A known risk of ECT treatment in a bipolar patient is ECT-induced mania, which iatrogenically places a patient in a potentially dangerous phase of their illness.
Who should not get ECT therapy? ›
For example, children under age eleven cannot undergo ECT for mental health disorders. People with heart conditions and people who cannot handle short-acting sedatives or muscle relaxers should not undergo ECT treatments. In pregnant patients, ECT does not pose any serious risk to the fetus, or the expectant mother.
The main source of continuing controversy concerns a possible adverse effect: memory loss. There is no question that ECT causes some memory loss, particularly of events near the time of the treatment. These memories often return, however.
What does ECT do to a healthy brain? ›
While no one knows precisely how ECT works, the consensus among brain stimulation experts is that the treatments do many things at the same time for the brain including enhancing brain chemicals, regulating the hormone system, and improving communication between different parts of the brain.
How many people died from electroshock therapy? ›
Risk of death
A meta-analysis from 2017 found that the death rate of ECT was around 2.1 per 100,000 procedures. A review from 2011 reported an estimate of the mortality rate associated with ECT as less than 1 death per 73,440 treatments.
What is the long term outlook for ECT patients? ›
Long-term effects of ECT
There were differences in several aspects of learning and memory in patients who had or had not received ECT remotely, suggesting that there may be sustained impairment in patients who have had ECT that exceeds that for patients with BD only.
Is ECT high risk? ›
ECT is a relatively safe and low-risk procedure that is helpful in the treatment of depression, suicidality, severe psychosis, food refusal secondary to depression, and catatonia. It requires interprofessional care coordination among anesthesiologists, psychiatrists, and nurses.
What is the remission rate of ECT? ›
Remission, which is the likelihood of having complete resolution of symptoms, is reported to range from 70 to 90 percent with ECT.
