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Evaluation of Electric Convulsion Therapy as Compared with Conservative Methods of Treatment in Depressive States

Royal Edinburgh Hospital for Mental and Nervous Disorders

ABSTRACT

In this survey 923 patients suffering from a depressive state were studied throughout their various hospitalizations, which amounted to 1,611: 608 were female patients with 1,054 hospitalizations, and 315 were male patients with 557 hospitalizations.

For purposes of comparison three groups were selected as follows:

1. First control group—hospitalizations of the period 1930–39, when E.C.T. was not available as a method of therapy.
   
2. Second control group—hospitalizations of the period 1940–48, when E.C.T., although available, was not utilized for treatment.
   
3. Treated group—hospitalizations of the period 1940–48, when E.C.T. was the treatment of choice.
   

The two "Control" groups and the single "Treated" group were compared in relation to (a) percentage rate of recovery, (b) duration of hospitalization, and (c) frequency of readmission.

1. The percentage rates of recovery in the various groups were (see Table at top of p. 1091).
   Thus, the percentage rate of recovery does not vary greatly whether patients are treated conservatively or with electric convulsion therapy. Such slight differences as may exist are statistically insignificant.
   
2. Duration of Hospitalization.
   It was found that the use of E.C.T. did not shorten the duration of hospitalization to any significant degree.
   
3. Frequency of Readmission.
   
   1. In the period within 6–12 months of discharge—
      1. The majority of cases discharged "Improved" in both control and treated groups had a higher percentage of relapse than those discharged "Recovered."
         
      2. Cases discharged "Recovered" in the treated group had a higher incidence of relapse than similar cases in the control groups.
         
      
      
   2. When more than 12 months had elapsed since discharge from hospital the incidence of recurrence increased with the length of the chronological period through which the patient was followed up.
      
   3. The greater the number of previous hospitalizations, the higher the percentage of relapse.
      
   
   

Conclusion.—Although the statistical evidence in this survey does not prove that E.C.T. increases recovery rate, decreases duration and prevents recurrence in depressive states, clinical observation testifying to its value cannot be disregarded. Convulsion therapy frequently ameliorates symptoms and renders the illness more bearable, and it would therefore appear to act by stimulating the mechanisms which bring about spontaneous recovery. Increased knowledge regarding its mode of action may therefore lead to increased understanding of depression as a clinical entity. The absence of such information stresses the continued necessity of detailed study of the individual patient and his symptoms in their total setting.

Received for publication June 2, 1950.