Hostname: page-component-7c8c6479df-ws8qp Total loading time: 0 Render date: 2024-03-27T10:50:10.063Z Has data issue: false hasContentIssue false

Who Responds to Electroconvulsive Therapy?

A Comparison of Effective and Ineffective Forms of Treatment

Published online by Cambridge University Press:  02 January 2018

Christina Sobin
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University and Department of Biological Psychiatry, New York State Psychiatric Institute, New York, US
Joan Prudic
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University and Department of Biological Psychiatry, New York State Psychiatric Institute, New York, US
D. P. Devanand
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University and Department of Biological Psychiatry, New York State Psychiatric Institute, New York, US
Mitchell S. Nobler
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University and Department of Biological Psychiatry, New York State Psychiatric Institute, New York, US
Harold A. Sackeim*
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University and Department of Biological Psychiatry, New York State Psychiatric Institute, New York, US
*
Dr H. A. Sackeim, Department of Biological Psychiatry, New York State Psychiatric Institute, 722 West 168th Street, New York, NY 10032, US

Abstract

Background

It has been reported that real ECT is more effective than simulated treatment among depressed patients with delusions and/or retardation, and that ECT is not effective among depressed patients who lack these features.

Method

In two randomised, double-blind studies, 143 patients with major depression were subtyped regarding psychosis, retardation and agitation. In both studies, low dosage, right unilateral ECT was ineffective compared with other forms of ECT. This report examined whether the depressive subtypes differed in clinical response to the ineffective and effective forms of ECT.

Results

The therapeutic advantage of effective forms of ECT was similar across the depression subtypes. Patients who lacked both psychosis and retardation showed this pattern.

Conclusions

The findings cast doubt on the utility of these depression subtypes in predicting ECT response. ECT is a viable treatment option for patients with major depression regardless of the presence or absence of psychosis, retardation and/or agitation.

Type
Papers
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Black, S. W., Winokur, G. & Nasrallah, A. (1993) A multivariate analysis of the experience of 423 depressed inpatients treated with electroconvulsive therapy. Convulsive Therapy, 9, 112120.Google Scholar
Brandon, S., Cowley, P., McDonald, C., et al (1984) Electroconvulsive therapy: results in depressive illness from the Leicestershire trial. British Medical Journal, 288, 2225.CrossRefGoogle ScholarPubMed
Buchan, H., Johnstone, E., McPherson, K., et al (1992) Who benefits from electroconvulsive therapy? Combined results of the Leicester and Northwick Park trials. British Journal of Psychiatry, 160, 355359.CrossRefGoogle ScholarPubMed
Carney, M. W. P., Roth, M. & Garside, R. F. (1965) The diagnosis of depressive syndromes and the prediction of ECT response. British Journal of Psychiatry, 111, 659674.Google Scholar
Clinical Research Centre (1984) The Northwick Park ECT trial: predictors of response to real and simulated ECT. British Journal of Psychiatry, 144, 227237.Google Scholar
Coryell, W. & Zimmerman, M. (1984) Outcome following ECT for primary unipolar depression: a test of newly proposed response predictors. American Journal of Psychiatry, 141, 862867.Google Scholar
Endicott, J. & Spitzer, R. L. (1978) A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry, 35, 837844.Google Scholar
Freeman, C. P., Basson, J. V. & Crighton, A. (1978) Double-blind controlled trial of electroconvulsive therapy (ECT) and simulated ECT in depressive illness. Lancet, i, 738740.CrossRefGoogle Scholar
Gregory, S., Shawcross, C. R. & Gill, D. (1985) The Nottingham ECT Study. A double-blind comparison of bilateral, unilateral and simulated ECT in depressive illness. British Journal of Psychiatry, 146, 520524.Google Scholar
Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278296.Google Scholar
Hamilton, M. (1986) Electroconvulsive therapy. Indications and contraindications. Annals of the New York Academy of Sciences, 462, 511.Google Scholar
Hobson, R. F. (1953) Prognostic factors in ECT. Journal of Neurology, Neurosurgery and Psychiatry, 16, 275281.Google Scholar
Johnstone, E. C., Deakin, J. F., Lawler, P., et al (1980) The Northwick Park electroconvulsive therapy trial Lancet, ii, 13171320.Google Scholar
Lock, T. & McCulloch, J. (1991) Local cerebral glucose utilization after chronic electroconvulsive shock: implications for the mode of action of electroconvulsive therapy. Journal of Psychopharmacology, 5, 111119.Google Scholar
Mendels, J. (1965) Electroconvulsive therapy and depression. I. The prognostic significance of clinical factors. British Journal of Psychiatry, 111, 675681.CrossRefGoogle ScholarPubMed
Nobler, M. S. & Sackeim, H. A. (1996) Electroconvulsive therapy: clinical and biological aspects. In Predictors of Response in Mood Disorders (ed. Goodnick, P. J.), pp. 177198. Washington, DC: APP.Google Scholar
O'Leary, D., Gill, D., Gregory, S., et al (1995) Which depressed patients respond to ECT? The Nottingham results. Journal of Affective Disorders, 33, 245250.Google Scholar
Prudic, J., Sackeim, H. A. & Devanand, D. P. (1990) Medication resistance and clinical response to electroconvulsive therapy. Psychiatry Research, 31, 287296.Google Scholar
Sackeim, H. A. (1986) The efficacy of electroconvulsive therapy. Annals of the New York Academy of Sciences, 462, 7075.Google Scholar
Sackeim, H. A., Decina, P., Kanzler, M., et al (1987a) Effects of electrode placement on the efficacy of titrated, low-dose ECT. American Journal of Psychiatry, 44, 14491455.Google Scholar
Sackeim, H. A., Decina, P., Prohovnik, I., et al (1987b) Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments. Archives of General Psychiatry, 44, 355360.Google Scholar
Sackeim, H. A., Prudic, J., Devanand, D. P., et al (1993) Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. New England Journal of Medicine, 328, 839846.Google Scholar
Scott, A. (1995) ECT and depressive disorders. In The ECT Handbook: The Second Report of the Royal College of Psychiatrists' Special Committee on ECT (ed. Freeman, C. P.), pp. 35. London: Royal College of Psychiatrists.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773782.Google Scholar
West, E. D. (1987) Electric convulsion therapy in depression: a double-blind controlled trial. British Medical Journal, 282, 355357.Google Scholar
Zimmerman, M., Coryell, W. & Pfohl, B. (1985) The treatment validity of DSM–III melancholic subtyping. Psychiatry Research, 16, 3743.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.