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Evidence summaries

Electroconvulsive Therapy for Severe Depression

Electroconvulsive therapy is more effective than simulated ECT or antidepressant drugs for symptom reduction in severe depression. Level of evidence: "A"

A topic in Clinical Evidence 1 summarizes the results of a systematic review 2 on electroconvulsive therapy (ECT) in depression. Compared to simulated ECT (6 RCTs, 256 people), ECT improved symptoms over 1-6 weeks (mean difference, Hamilton Depression Rating Scale score (HAM-D) 9.7, 95% CI 5.7 to 13.5). Compared to antidepressant drugs (18 RCTs, 1144 people) ECT improved symptoms over 3-12 weeks (mean difference, HAM-D 5.2, 95% CI 1.4 to 8.9). Bilateral ECT was more effective than unilateral ECT and high-dose ECT was more effective than low-dose ECT. The studies were underpowered to detect rare adverse events. Short-term cognitive impairment immediately after ECT was observed, but there was no evidence of long-term cognitive impairment at 6 months according to one RCT.

References

  • Geddes J, Butler R, Hatcher S, Cipriani A. What are the effects of treatments in mild to moderate or severe depression? Clinical Evidence 2005;13:1244-1263.
  • UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003 Mar 8;361(9360):799-808. [PubMed]

Primary/Secondary Keywords