Analysis of the efficacy and safety of electroconvulsive therapy in elderly patients: a retrospective study in the Polish population

OBJECTIVES

The aim of the study was to assess the efficacy and safety of electroconvulsive therapy in a population ≥ 65 years old.

METHODS

The study was naturalistic, retrospective. The study group included 65 patients, women and men, hospitalized in the departments of the Institute of Psychiatry and Neurology and undergoing ECT treatment. The authors analyzed the course of 615 ECT procedures performed in 2015-2019. The effectiveness of ECT was assessed using the CGI-S scale. Safety was assessed by analyzing side effects of the therapy, taking into account the somatic diseases in the study group.

RESULTS

As many as 94% of patients initially met the drug resistance criteria. In the study group, no serious complications such as death, life-threatening condition, necessity to be hospitalized in another ward or permanent health impairment were reported. In total, in the whole group, adverse effects were reported in 47. 7% of older patients, in the majority of cases (88%) they were of slight intensity and resolved without any particular intervention. The most frequently observed side effect of ECT was an increase in blood pressure (55. 4% of patients). Four patients did not complete ECT therapy due to side effects. In the majority of patients (86. 2%) at least 8 ECT treatments were performed. ECT turned out to be an effective method of treatment in the population of patients over 65 years of age - response to treatment was found in 76. 92% and remission in 49. 23% of the study group. The severity of the disease according to the CGI-S scale was on average 5. 54 before and 2. 67 after the ECT treatment.

CONCLUSIONS

Tolerance of ECT is worse after 65 years than in younger age groups. Most of the side effects are associated with underlying somatic diseases, mainly cardiovascular problems. This does not change the fact that ECT therapy is highly effective in this population and can be a very good alternative to pharmacotherapy, which, in this age group, is often ineffective or causes side-effects.

Right unilateral versus bilateral formula-based electroconvulsive therapy in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial

BACKGROUND

Electroconvulsive therapy (ECT) remains the most effective treatment of depression in the elderly population; however, it is still unclear which type of ECT is most beneficial in this population. The aims of this study were: (i) to assess the feasibility of a randomised controlled trial in elderly depressed patients treated with right unilateral (RUL) or fronto-temporal bilateral (BT) formula-based ECT; (ii) to compare formula-based RUL and BT ECT in terms of efficacy, safety and tolerability in this population.

METHODS

The study lasted 3 years and managed to randomise 29 patients over 65 years old to receive either BT (n = 14) or RUL (n = 15) ECT. Brief pulse width (0.5 ms) and age-based dosing method were applied. The clinical efficacy was assessed using Hamilton Depression Rating Scale, somatic state was monitored throughout the ECT course. In neuropsychological examination general cognitive performance, executive functions, verbal fluency, memory, autobiographical memory were evaluated.

RESULTS

The recruitment was poor due to small number of patients able to give informed consent. ECT proved to be a highly effective and safe method of treatment among elders. Formula-based RUL ECT did not differ from BT in antidepressant efficacy and had cognitive advantages - the indices of general cognitive performance, verbal fluency and memory were significantly better than before the treatment in the RUL group. Decline in retrieval consistency of autobiographical memory was more pronounced in the BT group, although it was observed across both groups.

CONCLUSIONS

Formula-based RUL ECT might not differ from BT in antidepressant efficacy and has an advantage in terms of tolerability.

Efficacy, safety and tolerability of formula-based unilateral vs bilateral electroconvulsive therapy in the treatment of major depression: A randomized open label controlled trial

Electroconvulsive therapy (ECT) remains the most effective treatment of depression, though it is still unclear which of its type is the most beneficial. The aim of this study was to compare the formula-based right unilateral ECT (RUL) with the fronto-temporal bilateral ECT (BT), in terms of their efficacy, safety and tolerability in patients with bipolar or unipolar depression. Ninety-one patients were randomly assigned to either BT (n = 45) or RUL (n = 46) ECT. Brief pulse width (0.5 ms) and a formula-based dosing method were applied. The clinical efficacy was assessed using the Hamilton Depression Rating Scale (HDRS-21).The somatic state was monitored throughout the ECT course and cognitive examination included: general cognitive performance, executive functions, visual-spatial functions, verbal fluency, verbal memory and autobiographical memory. Efficacy outcomes were not found to be significantly different between groups when using higher doses of energy in RUL ECT. Patients in RUL group were less likely to be confused and experienced increased blood pressure. The indices of general cognitive performance and verbal auditory memory were also significantly better this group, while BT ECT did not change these functions. Both ECT types resulted in a decline in the retrieval consistency of autobiographical memory that persists for at least three months and was significantly more marked in BT group as compared to RUL. In conclusion, formula-based RUL ECT does not differ from BT in antidepressant efficacy and has an advantage in terms of safety (lower incidence of increased blood pressure and fewer disturbances of consciousness) and tolerability (impact on cognitive functions).

What do medical students think about medical doctors with mental health issues?

Medical professionals tend to stigmatise people with mental issues. The study aimed to examine the attitude of medical students towards doctors with mental disorders. An anonymous online survey was created. Eleven psychiatric conditions were included and graded on a 0-4 scale to assess perceived security of working as a Medical Doctor (MD) with them. Based on the gradation the numeric variable called discriminative attitude was calculated. Five hundred answers were collected. The majority of the participants understood the need of consultancy by psychiatrist while suffering from mental disorders (70%). Students answered more harshly when assessing each of the eleven disorders separately, than for the general questions. There is a significant need for special anti-stigmatisation classes during university education.