Neurological Devices; Reclassification of Electroconvulsive Therapy Devices; Effective Date of Requirement for Premarket Approval for Electroconvulsive Therapy Devices for Certain Specified Intended Uses. Final order

The Food and Drug Administration (FDA) is issuing a final order to reclassify the electroconvulsive therapy (ECT) device for use in treating catatonia or a severe major depressive episode (MDE) associated with major depressive disorder (MDD) or bipolar disorder (BPD) in patients age 13 years and older who are treatment-resistant or who require a rapid response due to the severity of their psychiatric or medical condition, which is a preamendments class III device, into class II (special controls). FDA is also issuing this final order to require the filing of a premarket approval application (PMA) or a notice of completion of a product development protocol (PDP) for the preamendments class III ECT devices for all other uses that are not being reclassified to class II (product code GXC).

Medical Device Classification Procedures: Incorporating Food and Drug Administration Safety and Innovation Act Procedures. Final rule

The Food and Drug Administration (FDA, the Agency, or we) is issuing a final rule to amend its regulations governing classification and reclassification of medical devices to conform to the applicable provisions of the Federal Food, Drug, and Cosmetic Act (FD&C Act) as amended by the Food and Drug Administration Safety and Innovation Act (FDASIA). FDA is also making additional changes unrelated to the FDASIA requirements, to update its regulations governing the classification and reclassification of medical devices. FDA is taking this action to codify the procedures and criteria that apply to the classification and reclassification of medical devices and to provide for classification of devices in the lowest regulatory class consistent with the public health and the statutory scheme for device regulation.

Electroconvulsive therapy: administrative codes, legislation, and professional recommendations

Government regulatory involvement in electroconvulsive therapy (ECT) is due to several factors, including patient advocate groups, prior abuse by psychiatrists, and a general trend of state authority to move into areas traditionally governed by medical authorities. Regardless of the specific reasons, ECT is both highly effective in the treatment of many psychiatric disorders and heavily regulated by state administrative codes and legislation. The purpose of this article is to conduct a systematic review of the state administrative codes and legislation for the 50 states, the District of Columbia, and Puerto Rico and to compare the findings with professional recommendations for the administration of ECT.

Clinical predictors of short-term outcome in electroconvulsive therapy

OBJECTIVES

Electroconvulsive therapy (ECT) remains one of the most effective biological treatments for major depression. However, there is little information on the clinical use of ECT, and most studies were conducted before the introduction of newer antidepressants and before improvements in ECT delivery. This study examined ECT use in a university teaching hospital to determine predictors of short-term ECT outcome.

METHODS

This was a retrospective chart review of ECT over the period 1994-1996. Data extracted from the chart included demographic information, clinical features of depression, and documented antidepressant trials. Outcome measures, based on the chart notes, included Clinical Global Impression (CGI) and cognitive side effects of ECT at 1 week post-ECT or at discharge if sooner.

RESULTS

Of 174 patients who received ECT, 130 had a diagnosis of unipolar major depressive disorder. Of these 130 patients, 92% were refractory to at least 1 antidepressant medication. After a clinical course of ECT, 87% were rated as "much" or "very much" improved on the CGI. Moderate side effects were noted in 16% of patients, while only 7% had marked side effects. Medication resistance was not related to ECT response. No significant clinical predictors (symptoms, chronicity, number of antidepressant trials) of ECT outcome were found on a stepwise multiple-regression analysis.

CONCLUSIONS

These results support previous studies showing that ECT results in very good short-term response in major depressive disorder and that the cognitive side effects of ECT are reasonable. Despite the limitations of this study (retrospective, chart review, global measures), the results will inform clinicians who are recommending ECT for their patients.