ECT in depression

Abstract

Comments on a study by Schulze-Rauschenbach et al (see record [rid]2005-04940-010[/rid]), who found in their comparison of unilateral electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) that these two procedures have similar efficacy in the treatment of major depression. Euba's comments, however, that the rate of treatment response for ECT in this study was 46%, well below the figures found in other studies (Medical Research Council, 1965). The authors state that the response rate for ECT might have been higher if a higher dosage had been used, but that this would have increased the risk of side-effects. This argument is misleading, just as comparing a sub-therapeutic dose of amitriptyline and placebo would be. The authors should have compared the incidence of side-effects between treatments, but at therapeutic doses. This comparison would probably have confirmed the prevalent belief that ECT is more effective than rTMS in the treatment of major depression. Kirov et al comment that the rTMS methodology produced an impressive improvement with no cognitive side-effects, but that the reported similar treatment effect with ECT could be misleading, as it is partly due to the rather low success rate of ECT in this study. Kirov et al discuss an audit of ECT at their regional psychiatric hospital and says that they have observed a 55% improvement on Hamilton Rating Scale for Depression (HRSD) scores after at least six ECT sessions. Discusses reasons for the low response rate in the ECT group of Schulze-Rauschenbach et al. (PsycINFO Database Record (c) 2012 APA, all rights reserved)