Safe performance of ECT in severely ill patients: A retrospective study

Abstract

Background and Objectives: Electroconvulsive therapy (ECT) is nowadays known as a first line therapy in many certain illness conditions. Despite the fact that psychotic depression and treatment resistant depression are more common in geriatric psychiatry, the use of ECT is not. The aim of our study was to show that ECT can be safely performed even if patients show high comorbidity and are therefore per se at a higher risk for experiencing severe side effects. Methods: We examined 25 ECT treated and severely ill patients of advanced age (mean 66 years) by chart review. Results: Mean age corrected Charlson Comorbidity Index (CCI) was 4.1, mean Cumulative Illness Rating Scale for Geriatrics (CIRS-G) 10.5. Generally, ECT- related complications were rated as mild and short termed, 14 patients showed no complications at all. Complications did not correlate with age or comorbidity. Post hoc, we noted a significant advantage for the use of propofol or etomidate compared with thiopental as narcotic agents. Conclusions: Under optimized somatic treatment conditions ECT can be performed safely in comorbid patients of advanced age. However, a risk/benefit analysis should always be performed individually.