The safety of electroconvulsive therapy
Electroconvulsive therapy (ECT) had proven to be an effective tool in treating severe depression. It is able to relieve depressive symptoms in the majority of cases and is often effective when other methods of treatment have failed. Despite this, many patients are extremely reluctant to try ECT, and its use is highly stigmatized. Our ImPACT paper of the month addresses this issue. Lead author Dr. Tyler Kaster, his supervisor Dr. Simone Vigod, and their team studied the risks of ECT, to ensure that patients who are considering the treatment have the information they need to make an informed decision. We spoke to Dr. Kaster to learn more.
What is Electroconvulsive Therapy?
TK: Electroconvulsive therapy, or ECT, is an extremely effective treatment for severe depression. It uses an electrical stimulus to cause a generalized seizure while an individual is under general anesthesia. The exact mechanisms of action for ECT is not fully known, but it is able to achieve remission, or absence of depressive symptoms, in up to 80% of individuals.
What motivated this research?
TK: Prejudice and misconceptions about ECT are major barriers to individuals receiving treatment, with only about 1% of depressed individuals receiving ECT. One of the concerns expressed by many considering ECT is a “fear of death” despite evidence suggesting ECT for depression is a medically safe procedure. To address this concern, information on the risk of serious medical events associated with ECT treatment is required to enable individuals to make fully informed treatment decisions. Unfortunately, previous work has been unable to determine the effect of ECT on the risk for serious medical events separate from the underlying condition it is treating (i.e., depression). This study aimed to overcome these limitations and develop evidence that could be used to support the informed decision-making process for individuals who might be considering ECT treatment.
What was the most important finding of this study, in your opinion?
TK: Our most important finding was that there did not appear to be a clinically significant increased risk of serious medical events (i.e., medical hospitalization or death) amongst those who received ECT compared to those who did not in the 30 days following the first ECT treatment. In a secondary analysis, we also found that suicide death was significantly reduced amongst those who received ECT.
How does this change treatment for patients with depression in the future?
TK: This study provides reassuring evidence that ECT is safe and very unlikely to cause serious medical problems for individuals with severe depression. It suggests that concerns about serious medical events should not deter individuals from pursuing ECT. This work provides important information enabling individuals who are considering ECT to make fully informed decisions and hopefully reduces misconceptions about the medical risks associated with ECT.
Any next steps?
TK: The first step for this line work is to ensure the knowledge gained from this research is shared with individuals who may use this information including physicians, patients, and their loved ones. We then hope to build on this line of work by examining the relationship of ECT with other outcomes (e.g., suicide death or hospitalization) or in other populations (e.g., schizophrenia).
What is the major take home message for the public?
TK: The decision to pursue ECT is a complex one for patients and their loved ones that involves balancing risks and benefits of treatment. Numerous studies support the efficacy of ECT for depression and our study provides reassuring evidence regarding the safety and medical risks of ECT that can be used by individuals to make informed decisions about pursuing treatment.
ImPACT Committee includes Krista Lanctôt, Alastair Flint, Meng-Chuan Lai and Simone Vigod.
Kaster TS, Vigod SN, Gomes T, Sutradhar R, Wijeysundera DN, Blumberger DM. Risk of serious medical events in patients with depression treated with electroconvulsive therapy: a propensity score-matched, retrospective cohort study. Lancet Psychiatry. 2021 Aug;8(8):686-695. doi: 10.1016/S2215-0366(21)00168-1.