Electroconvulsive therapy improves quality of life in patients with major depression

Electroconvulsive therapy (ECT) improves mood, quality of life and activities of daily living in patients with major depression, according to researchers at Wake Forest University Baptist Medical Center.

"Quality of life and function are improved in ECT patients as early as two weeks after the conclusion of ECT," said Vaughn McCall, M.D., professor and chairman of the Department of Psychiatry and Behavioral Medicine and the lead author, writing in the November issue of the British Journal of Psychiatry.

ECT is a treatment for severe mental illness, especially major depression, in which a brief application of electric stimulus – a shock – is used to produce a generalized seizure.

"ECT produces a net improvement in health for most patients, and should help fill the knowledge gap that recently led to more restrictive guidance on the use of ECT in the United Kingdom," said McCall. "A restrictive attitude toward ECT is not warranted."

Britain's National Institute of Clinical Excellence (NICE) last year recommended sharp restrictions on the use of electroconvulsive therapy "until more information is available about ECT's effect on memory, quality of life and other pertinent health outcomes."

NICE, an arm of Britain's National Health Service, said ECT should be used "only to achieve rapid and short-term improvements of severe symptoms after other treatment options have failed and/or when the condition is considered to be potentially life threatening in individuals with severe depressive illness, catatonia or a prolonged or severe manic episode."

The study at Wake Forest Baptist included 77 patients with major depression, and the effects of depression were confirmed by use of several psychiatric measuring scales, some answered by the patients and some by clinicians. These tests were completed before and immediately after ECT and again at two weeks and four weeks after ECT.

McCall said that 66 percent of the patients showed improvement after ECT.

"The sample showed improvement in most measures of mood, cognition, quality of life and function" at both two weeks and four weeks after ECT, he said. The only decline was on an autobiographical memory test, but that test is designed to measure only memory loss, not improvement.

When he compared test results on nine of 10 psychological scales before ECT with the same tests repeated at both two and four weeks after ECT, the differences were statistically significant, meaning that they could not have happened by chance.

McCall said the new study confirmed earlier results at Wake Forest Baptist that function and quality of life improve after ECT "to a greater extent than medication-treated patients," but, he said, the prior study's first measurement was not made until four weeks after ECT.

McCall said the change in quality of life was largely related to changes in mood.

But there also was improvement on various measurements of cognition and especially of memory. "Although the improvement on neurological tests could be attributed to a practice effect [taking the same test several times], it is equally likely that they represent true improvements in cognitive efficiency," he said.

Also involved in the study were Peter B. Rosenquist, M.D., associate professor of psychiatry, and Aaron Dunn, B.A., an associate project manager in the Psychiatry Department.