The Pharmaceutical Journal
Vol 270 No 7240 p357
15 March 2003

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The Lancet (www.thelancet.com)

ECT may be better than drugs for short-term treatment of depression

Electroconvulsive therapy (ECT) is probably more effective than drug therapy as a short-term treatment for depression, a meta-analysis has shown.

However, there is less evidence that the benefits are maintained in the long term, say the United Kingdom ECT Review Group, which carried out the study. Non-randomised studies suggest that relapse rates are high after acute response to ECT, it says.

The group adds that continuation drug therapy could be an effective preventive strategy, but that this area was beyond the scope of its review. It adds that differences between ECT and drug therapy may be compounded by anaesthetics and nursing care involved in the ECT procedure. Subgroups thought to benefit in particular from ECT include the elderly, those with treatment-resistant depression and those with post-partum disorders. But because of "little randomised evidence" for these subgroups, the reviewers call for further trials.

The review highlights impairments in cognitive functioning as a result of ECT. These involved mostly changes in memory. Higher "doses" of ECT, though more effective, were more likely to cause impairment.

The report adds that ECT carried out to a high standard can maximise efficacy and minimise side effects. But it points out that, in general, standards of ECT across the UK are poor (Lancet 2003;361:799).