The following is a summary of “Adherence to clinical practice guidelines for using electroconvulsive therapy in elderly depressive patients,” published in the July 2024 issue of Psychiatry by Yrondi et al.
Electroconvulsive therapy (ECT), a highly effective treatment for mood disorders like major depressive episodes in both unipolar and bipolar disorder, remains underutilized, with older adults at higher risk for AEs.
Researchers conducted a retrospective study assessing the duration of major depressive episodes and the number of treatment lines before starting ECT in patients aged 65 and older, based on international guidelines for first-line indications.
They examined patients aged 65 and older with major depressive episodes (MDEs) in major depressive disorder (MDD) or bipolar disorder (BD) who had undergone ECT. Data was gathered on the duration of MDEs and the number of treatment lines before ECT. The reasons for ECT use were also documented, specifically first-line indications such as suicidality, urgency, catatonic and psychotic features, previous ECT response, and patient preference. Statistical comparisons between groups were performed using standard statistical tests.
The result showed 335 patients, with a mean duration of MDEs before ECT of approximately 9 months. The duration was shorter in patients with BD than with MDD, averaging about 7 months and 10 months, respectively. In the MDD group, chronic medical conditions extended the duration before ECT. Adherence to first-line indications for ECT from guidelines did not shorten the duration of MDEs before ECT, except in cases with a previous positive response to ECT. First-line indications did reduce the number of treatment lines before initiating ECT.
Investigators concluded that ECT is effective and safe for treating MDEs in older adults, but the delay before the administration remains excessive.
Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05933-7
