Electroconvulsive Therapy Safe, No Adverse Events on Cognition
By Thomas S. May
FLORENCE, Italy -- April 5, 2017 -- Electroconvulsive therapy (ECT) is safe and has no adverse effects on cognitive functioning, according to results of 2studies presented at the 25th European Congress of Psychiatry (EPA).
“Death caused by ECT is an extremely rare event,” noted Søren Østergaard, MD, PhD, Aarhus University Hospital, Risskov, Denmark, speaking here on April 4. ECT remains underutilised because of fears of cognitive and medical risks, even though it is a highly effective treatment for mood disorders and delirium, as well as acute and chronic psychoses, he added.
Dr. Østergaard and colleagues investigated the mortality rate associated with ECT by performing a systematic review and meta-analysis of 15 studies with data from 32 countries, reporting on a total of 766,180 ECT treatments. The review only included studies using “modified ECT,” which were performed under general anaesthesia and with muscle relaxation, and were performed after 1970, to reliably reflect modern practices and equipment.
Results showed that there were 16 cases of ECT-related death in the included studies, yielding an ECT-related mortality rate of 2.1 per 100,000 treatments (95% confidence interval [CI]: 1.2 to 3.4). In the 9 more recent studies published after 2001 (covering 414,747 treatments), there was only 1 reported ECT-related death.
The investigators calculated ECT-related mortality rate by dividing the total number of ECT-related deaths by the total number of ECT treatments. The 95% CI of this estimate was calculated using Bernoulli’s principle of distribution.
In a related, prospective study, Sabrina Mörkl, MD, Medical University of Graz, Graz, Austria, and colleagues investigated the effects of ECT on cognition in patients with major depression. They presented their results here on April 3.
Dr. Mörkl and colleagues enrolled 23 patients (10 male) who met the criteria of treatment-resistant depression according to International Classification of Diseases (ICD)-10 code.
Analysis of the results before and after ECT showed that patients experienced highly significant changes in scores on the Beck Depression Inventory (BDI) (P = .028) and the Montgomery-Asberg Depression Rating Scale (MADRS) (P = .001), but no significant changes occurred in any of the tests measuring cognitive function (Mehrfachwahl-Wortschatz-Intelligenztest, Trail Making Test A and B, Stroop Test, Mini Mental State Examination, and the Münchner Gedächtnistest, the German version of the California Verbal Learning Test).
The investigators cautioned that larger studies are needed to confirm these findings.
[Presentation titles: A Systematic Review and Meta-analysis of the Mortality Rate of Electroconvulsive Therapy (ECT); Cognitive Function Before and After Electroconvulsive Therapy in Patients with Major Depression. Abstracts ED782 and ED400]