Electroconvulsive therapy improves quality of life in patients with severe depression

Patients whose severe depression goes into remission for six months following electroconvulsive therapy report a quality of life similar to that of healthy individuals, researchers say.

"If we can get you into remission, you get this big, big improvement in quality of life at six months such that our patients' quality of life is as good as that of the overall general population," said Dr. W. Vaughn McCall, Chairman of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Georgia Regents University.

Researchers looked at quality-of-life questionnaires filled out by more than 500 patients, rating themselves on topics such as physical function, pain, vitality and social function. About half the patients went into remission after ECT and researchers completed their information gathering, including pre- and post-ECT quality-of-life measures, on 64 patients who remained in remission at six months.

Essentially all the patients headed for ECT had poor quality-of-life scores before treatment, reflecting a severity of disease that made them strong candidates for the therapy. Researchers compared those scores to depressed patients who did not receive ECT as well as a group of about 500 healthy individuals.

After therapy, the worst scores generally normalized. The not-so-great news was that not enough patients stayed in remission, notes McCall, an expert in depression and ECT and corresponding author of the study in the Journal of Affective Disorders. "We need to look at different drug treatments for patients to prevent relapse." In fact, McCall and others have early evidence that ECT patients who also take antidepressants fare better. Antidepressant use was not restricted in this study. "The other possibility is that there are some people who seem to respond to nothing but ECT and will need booster ECT sessions to stay well," he said.

Interestingly, after successful therapy, ECT patients scored themselves higher on bodily pain and mental health than their healthy peers. However patients reported that their emotional role - the ability to relate to others and feel empathy which received the lowest score pre-therapy - did not return to normal or near-normal levels. That poor showing could mean these patients may not be optimally effective in their work and other regular activities, the researchers said.

"What I tell patients is that six months after this is over, my expectation is that you will be better off, not just in terms of your depression, I mean globally, in your quality of life. The trick is going to be keeping you well so you do not slide back into depression. That is the biggest risk."

Ideal candidates for ECT tend to be severely depressed individuals who have failed multiple drug therapies, McCall said. Less commonly, patients present with severe disease, for example, the first time they are seen is in the emergency room after a suicide attempt.

Often, ECT patients do relapse into depression months after successful ECT and may eventually get additional ECT. Over a lifetime, a depressed patient could receive a handful of courses with eight-10 sessions in each course. In the United States, ECT is used almost exclusively for depression and occasionally for mania and schizophrenia, McCall said. Therapy includes a short, controlled burst of electricity to the brain via electrodes placed on the scalp. Patients receive an anesthetic and muscle relaxer to help ensure safety and comfort.

Comments

  1. Deirdre Oliver Deirdre Oliver Australia says:

    Re: Dr Vaughan McCall's "study" on `quality of life' following ECT'. I read this work two days ago. It was a novel view on a controversial issue, and deserved a fair and reasonable approach. I have to say that this "study" was one of the most inept, sloppy, poorly designed efforts that I have ever seen. It was so bad that if a grade 8 student had presented this work to me as an example of scientific method I would have failed him/her on the spot. The first thing that alerted me was that the majority of his references were from his own previous work. I put that aside because in my experience of looking at many other psychiatric research studies, that, though poor science, it is common amongst these researchers. So I looked at his selection requirements for his subjects. There were only 77. An immediate and automatic bias is that it was most unlikely that any were hostile to ECT, so we're looking at a `hopeful' group, desperate and eager to please. This is an inherent danger in these kinds of studies but can be controlled for to some degree. There didn't seem to be such a control in this case. The `intimidation' factor does not appear to have been controlled for either. (This is the very common problem of the patient telling the doctor what he wants to hear. It, too, can be controlled, but didn't appear to be). We do not know how many of these people were in-patients at the time they were asked to participate. None, he stated, had had ECT treatments less than four months, (six months is the normal cut-off time for relapse and is well documented), earlier. He did not enlighten us on how many of his sample belonged to this group. This is important because we assume, (as we had to), that these patients had relapsed quite severely within that time in order to meet his criteria of severe depression. (How desperate they might have been could have been significant). There is ample data that supports that EEG abnormalities from ECT are still present in many people up to six months  following ECT and are occasionally still present at 12 months. There was no mention of how many others had had ECT before and how many, how much or when. He claimed that all subjects had been taken off the anti-depressants prior to treatment but did not say for how long. Anti-depressants commonly remain in the person's system for at least 6 weeks after cessation. He also interviewed the subjects and very clearly, (his claim), told them all the details of the study, thus leaving himself and his colleagues wide open to suggestions of bias. While ECT is a powerfully active treatment, placebo effects exist and have to be controlled for. This single occurrence compromises this. There were other issues that he appeared not to have controlled for. He had no control over how many treatments were given to each patient. That, as well as the choice of drugs given following the ECT were controlled by the `attending physician'. As far as we know there may have been several of these whose patients were the subjects. This is not the place to take this dismal effort to pieces on every point. Believe me I and any sensible, disciplined observer could. I was disgusted that I'd wasted so much time on this but I did glance further down the work and discovered that the files of nearly half the subjects, had been `mislaid' before the end of the trial. Surely that was the time to abandon the whole thing. But he dismissed this and moved on to state that 37 subjects had relapsed by one week following the treatment. At this point it was clear to me that the entire effort was irrevocably compromised. His large number of tests, (some, very suspect), included the MMSE which is a gross questionnaire aimed at detecting dementia and is totally inappropriate in this case. His `baseline' tests were those given when the subjects were severely depressed just before the study began. In my experience, `baseline' means when the person is well and not depressed. But, in this case, when the tests were given, a week after the cessation of treatments, at least half were still, or again depressed, and the rest would have had significant EEG abnormalities. Also, he decided not to include the single most reported problem, memory loss, stating that he did not consider that memory loss would be a major factor affecting `quality of life' post ECT. Try telling that to the people who can no longer work, whose lives are terribly affected when they can't remember their children. This work is a travesty and Dr. McCall is an embarrassment to his colleagues.
    Deirdre Oliver

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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