Cognition, Quality of Life Improves After ECT for Depression
November 15, 2004
By Karla Gale

NEW YORK (Reuters Health) -- Electroconvulsive therapy (ECT) is associated with early improvements in mood, quality of life, and global cognition in patients with major depression, according to a research team at Wake Forest University Health Sciences, Winston-Salem, North Carolina.

Although ECT effectively treats major depression, the UK's National Institute for Clinical Excellence recently recommended that the use of ECT be limited until more information regarding its effects on quality of life (QOL) become available.

Therefore, lead investigator Dr. W. Vaughn McCall and colleagues examined ECT's antidepressant efficacy, along with the treatment's cognitive side effects and impact on changes in function and QOL. They report their findings in the November issue of the British Journal of Psychiatry.

Included were 77 patients with major depressive episode. Illness severity, cognition, function and QOL were assessed with standardized tests 1 to 3 days prior to the first ECT and 2 and 4 weeks after ECT was completed.

On average, every measure of mood, cognition, QOL and function showed improvement at 2 and 4 weeks, the authors report, except for autobiographical memory, which only tests memory loss and not improvement.

For example, Hamilton Rating Scale for Depression improved from 28.9 at baseline to -44.1 at 2 weeks and -45.7 at 4 weeks (p < 0.001). Corresponding scores on the Rey Figure test were 13.7, 52.9 and 65.9 (p < 0.001).

Changes in QOL were related to change in mood, their findings showed, while improvement in function was most closely matched by changes in cognition.

ECT is thus an important option for patients with depression, Dr. McCall told Reuters Health. There are two types of situations that call for its use: either catastrophic illness where the patient's life is in danger, or for patients with major depression that impairs their ability to function and is resistant to more conservative treatment with medication and psychotherapy.

In fact, he noted, when the patients were asked if they would choose ECT as a treatment option if they became sick again, fewer than 20% said they would be unlikely to do so.

"The results are consistent with the premise that ECT produces a net improvement in health for most patients, and should help fill in the knowledge gap that recently led to more restrictive guidance on the use of ECT in the United Kingdom," Dr. McCall's team concludes.

Br J Psychiatry 2004.