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Ask the Mental Health Expert Archives 2001-2004

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ECT for Depression

Q. I understand that Electro-Convulsive Therapy (ECT) is the most effective treatment available for serious, unremitting depressions. Is there evidence that ECT is equally effective for agitated and vegetative depressions? I recognize that it has proven effective in bipolar disorder. One might suggest that the manic phase of the bipolar disorder is like an agitated depression and therefore, the agitated depression is LIKELY to be help by ECT. However, are there recent studies confirming that ECT is effective for the treatment of serious agitated depression?

A. I think it might be fair to say, "There is no credible evidence that ECT is not useful for agitated depression, and some evidence that it is useful in such cases." For example, in the Nottingham electroconvulsive therapy (ECT) trial, O'Leary et al (J Affect Disord 1995 Apr 4;33(4):245-50) used a simulated (control) treatment group to test prospectively the power of delusions or agitation to predict response.

The response of patients without retardation and without delusions was examined retrospectively as well because of doubts over the usefulness of ECT for this subgroup. Deluded/nondeluded and agitated/nonagitated subtypes both responded significantly to real ECT treatment. Neither delusions nor agitation predicted greater treatment response. Patients without retardation, with or without delusions, responded to real ECT. Similarly, Avery & Sliverman (J Affect Disord 1984 Aug;7(1):67-76) studied patients with primary affective disorder who had either psychomotor agitation alone or psychomotor retardation alone.

Compared to psychomotor retardation, psychomotor agitation was seen more frequently in women, older patients, and individuals who have a late onset to their illness. These researchers actually found that those with agitation alone appeared to have a better and faster response to electroconvulsive therapy.

On the other hand, there is at least one study suggesting that patients who are neither psychomotorically retarded nor deluded do not benefit significantly from real as opposed to simulated ECT (Buchan et al, Br J Psychiatry 1992 Mar;160:355-9).

Finally, there is a case report from Diaz-Cabal et al (J Clin Psychiatry 1986 Jun;47(6):322-3) on a patient with hyperthyroidism and agitated depression. Her depression and (curiously) her thyroid hyperfunction responded to electroconvulsive therapy. In short, I think the preponderance of the evidence points to efficacy for ECT in major depression with psychomotor agitation.

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February 2003

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