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Meta Analysis Shows Electroconvulsive Therapy May Be Justified For Depression Treatment

A systematic overview and meta analysis of published evidence supports the use of electroconvulsive therapy (ECT) as a short-term treatment for depression.

The review of 73 randomised controlled trials and observational studies showed ECT treatment may be better than drug therapy as a short-term, declare Dr. John Geddes and colleagues at the University of Oxford, in England, and collaborators from the UK ECT Review Group.

Their review involved trials comparing ECT with 'sham' ECT, ECT compared with drug therapy, bilateral ECT compared with unilateral ECT, and high-dose compared with low- dose ECT.

Dr. Geddes and colleagues point out that ECT has been used in psychiatry since the 1930s. Views on ECT vary, from researchers who consider that it is probably ineffective but certainly causes brain damage, to those who think it is the most effective treatment available in psychiatry and is completely safe.

The main outcome measures in the review were decreases in depressive symptoms after therapy, symptom status after 6-month follow-up, effect on cognitive function and on mortality.

Real ECT was significantly more effective than simulated ECT (six trials, 256 patients) and significantly more effective than pharmacotherapy (18 trials, 1,144 patients). Bilateral ECT was more effective than unipolar ECT (22 trials, 1,408 patients) and high dose ECT was more effective than low dose.

"It is clear that any attempt to simplify our findings to one strategy for all clinical situations (one size fits all) will be unhelpful," Dr Geddes and colleagues write. "Thus, it is not possible to recommend the exclusive routine use of either unilateral or bilateral ECT because it is likely that specific clinical circumstances may need one or the other."

They concluded that "there is a reasonable evidence base for the use of ECT: it does not rest simply on anecdote, habit, and tradition. The trials that have been done reflect concerns that were uppermost at the time. In the 1970s, this concern was efficacy of electroshock per se, more recently it has been dose and site of shock administration. ECT remains an important treatment option for the management of severe depression."
Lancet 2003;361:799-808.

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