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Electroconvulsive Therapy (ECT) Prof. Philip Cowen Professor of Psychopharmacology Department of Psychiatry University of Oxford, UK

ECT for TRD

ECT for TRD Population Response rate Antidepressant-resistant patients Non-treatment-resistant patients Heijnen WT, Birkenhäger TK, Wierdsma AI, et al (2010) Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: a meta-analysis. Journal of Clinical Psychopharmacology, 30: 616–9.

ECT for TRD Population Response rate Antidepressant-resistant patients 50% Non-treatment-resistant patients 65% Heijnen WT, Birkenhäger TK, Wierdsma AI, et al (2010) Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: a meta-analysis. Journal of Clinical Psychopharmacology, 30: 616–9.

When to use ECT Patients with severe distress, disabled Not helped by pharmacological or psychological treatments

When to use ECT Patients with severe distress, disabled Not helped by pharmacological or psychological treatments Depressive psychosis Severe depression Hard to maintain adequate nutrition and fluid intake

ECT: relapse rates High relapse rates 50% over 6 months Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR* D report. American Journal of Psychiatry 163, 1905-17. Kellner CH, Knapp RG, Petrides G, et al (2006) Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Archives of General Psychiatry, 63: 1337–4

ECT: relapse rates High relapse rates 50% over 6 months Relapse rate is also high after pharmacological treatment Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR* D report. American Journal of Psychiatry 163, 1905-17. Kellner CH, Knapp RG, Petrides G, et al (2006) Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Archives of General Psychiatry, 63: 1337–4

ECT: relapse rates Maintenance treatment High relapse rates Lithium + nortriptyline As effective as maintenance ECT High proportion of patients relapsed High relapse rates 50% over 6 months Relapse rate is also high after pharmacological treatment Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR* D report. American Journal of Psychiatry 163, 1905-17. Kellner CH, Knapp RG, Petrides G, et al (2006) Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Archives of General Psychiatry, 63: 1337–4

Key Points Consider ECT Depressive psychosis Problems maintaining adequate nutrition and hydration Suicidality Failure to respond to several pharmacological and psychological treatments Significant distress and disability

Key Points Consider ECT Depressive psychosis Problems maintaining adequate nutrition and hydration Suicidality Failure to respond to several pharmacological and psychological treatments Significant distress and disability

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