ECT should be treatment option in all cases of refractory depressionBMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7126.233 (Published 17 January 1998) Cite this as: BMJ 1998;316:233
- Niall Gormley, Senior registrara
Editor-In the ABC of Mental Health, Hale highlights the poor response of psychotic depression to antidepressants alone.1 His assertion that electroconvulsive therapy is effective only for depressed patients who are either deluded or have marked psychomotor retardation is not, however, supported by the findings of recent studies of the outcome of the treatment.
Combined results of the Northwick Park and Leicester randomised controlled trials raised the concern that electroconvulsive therapy is an effective treatment of depression only in patients with delusions or retardation.2 This pattern was not confirmed in the Nottingham trial, which found that real electroconvulsive therapy was more effective than simulated treatment in both non-retarded and non-deluded patients.3 The relation between depressive subtype and outcome was also evaluated in two randomised controlled trials in New York.4 The authors reported a 70% response rate to effective forms of electroconvulsive therapy, which was unrelated to the presence of psychosis or retardation.
Electroconvulsive therapy is frequently considered to be a “last resort” in the treatment of depressive illnesses that lack psychotic features or psychomotor retardation. This is of concern when one considers that a longer duration of the index episode emerges as a consistent predictor of non-response in studies of the outcome of electroconvulsive therapy.5 The favourable response rates of depressive illness that is resistant to drug treatment supports the view that electroconvulsive therapy should be considered to be a treatment option in refractory depression, regardless of the clinical subtype.