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

3. ECT for TRD

4. 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.

5. 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.

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

7. 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

8. 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,
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

9. 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,
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

10. 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,
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

11. 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

12. 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

13. Next Presentation: Transcranial Magnetic Stimulation (TMS) and Vagal Nerve Stimulation (VNS)