Electroconvulsive Therapy Effectiveness

Researchers are still divided regarding the validity of ECT, and the publications that argue for its efficacy do so only for short terms of one to six months.

The 1999 U.S. Surgeon General's Report on Mental Health summarized psychiatric opinion at the time about the effectiveness of ECT.

It stated that both clinical experience and published studies had determined ECT to be effective (with an average 60 to 70 percent remission rate) in the treatment of severe depression, some acute psychotic states, and mania.

Its effectiveness had not been demonstrated in dysthymia, substance abuse, anxiety, or personality disorder.

The report stated that ECT does not have a long-term protective effect against suicide and should be regarded as a short-term treatment for an acute episode of illness, to be followed by continuation therapy in the form of drug treatment or further ECT at weekly to monthly intervals.

A 2004 large multicentre clinical follow-up study of ECT patients in New York—describing itself as the first systematic documentation of the effectiveness of ECT in community practice in the 65 years of its use—found remission rates of only 30 to 47 percent, with 64 percent of those relapsing within six months.

However, when patients with co-morbid personality disorders or who were suffering from schizoaffective disorder were removed from the analysis, the remission rates climbed to 60-70%. The relapse rate in the first six months is reduced by the use of psychatric medications or further ECT, but remains high.

All systematic published reviews of the literature have concluded that ECT is effective in the treatment of depression. In 2003,

The UK ECT Review group published a systematic review and meta-analysis comparing ECT to placebo and antidepressant drugs. This meta-analysis demonstrated a large effect size for ECT versus placebo, and versus antidepressant drugs.

In 2006, research psychiatrist Colin A. Ross reviewed the placebo-controlled trials one-by-one and found that no single study showed a significant difference between real and placebo ECT at one month post-treatment.

Dr. Ross was highly critical of other published reviews concluding that ECT was effective, because it stated these reviews often relied primarily on studies that were not placebo-controlled.

However, Dr. Ross's analysis does not include a statistical synthesis in contrast to the well conducted meta-analytic evidence presented by the UK ECT review group in 2003.

Further Reading

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