Original articleEffectiveness of electroconvulsive therapy in community settings
Section snippets
Study sites and study participation
The study was conducted at seven hospitals in the New York City metropolitan area. The sites included two private psychiatric hospitals, three community general hospitals, and two hospitals at university medical centers. A clinical outcomes evaluator was assigned to each hospital and collected all the research information. These evaluators conducted clinical and neuropsychological research assessments and obtained data on clinical and treatment history. They had no involvement or impact on the
Results
Of the 751 patients scheduled to receive ECT at the 7 sites, 398 (53.0%) consented to study participation (Figure 1). Of the 353 patients who did not enter the study, 128 (36.3%) patients met one or more exclusion criteria, with a psychiatric diagnosis other than a depressive disorder being the most common (n = 46, 13.0%). Of the remaining 225 patients who might have been eligible, the most common reasons for nonparticipation were insufficient time before the first ECT treatment to conduct the
Discussion
We have provided evidence that ECT is substantially less effective in community practice than previously assumed from the results of clinical trials. Whereas the rate of remission in clinical trials is typically reported to be on the order of 70%–90% American Psychiatric Association, 2001, Petrides et al., 2001, Sackeim et al., 1993, Sackeim et al., 2000, the intent-to-treat remission rates from a large cohort of adults treated with ECT in community facilities were in the range of 30%–47%. The
Acknowledgements
This work was supported in part by Grants R01 MH59069 (JP, MO, HAS), R01 MH35636 (HAS, JP), and R01 MH61609 (HAS, JP) from the National Institute of Mental Health.
We thank the electroconvulsive therapy directors at the participating institutions, as well as the medical staffs, for their assistance in conducting this study.
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2022, Journal of Affective DisordersCitation Excerpt :Therefore, in our RCT it was tested whether an experimental intervention (EMR-ECT) could increase and speed-up response, but this proved not be the case (Scheepens et al., 2020). In our sample, 42% and 25% of the patients reached criteria for ‘response’ and ‘remission’ after the ECT-course, respectively, which is comparable to the response rate of other studies (Prudic et al., 2004). The putative working mechanisms of ECT still remain unclear, though our study suggests – for the first time - that ECT may have the ability to remediate negative schemas in patients.
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2022, Schizophrenia ResearchIndividual response to electroconvulsive therapy is not correlated between multiple treatment courses
2022, Journal of Affective DisordersCitation Excerpt :Indeed, clinical guidelines include prior response to ECT as an indication for future treatment (Tess and Smetana, 2021). Additionally, clinical trials of ECT efficacy demonstrate wide variations in the number of participants that had undergone ECT treatment prior to the trial, with anywhere from 0 – 58% of patients reporting a previous series of ECT treatment (Anderson et al., 2017; Eranti et al., 2007; Prudic et al., 2004; van den Broek et al., 2006; Wijkstra et al., 2000; Yildiz et al., 2010). Most prospective trials have not stratified response rate on the basis of prior ECT, and none has reported outcomes of the same patient across multiple ECT treatment courses during distinct mood episodes.