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ECT for Recurrent Major Depression

Electroconvulsive therapy (ECT) is an effective treatment for episodes of severe major depression, with or without psychosis, and often works when medication trials have failed. However, stigma, fear of memory problems after treatment, and concern about cost have limited its use as a first-line treatment for depression. This study used a 1993 database of 913 community hospitals in 17 states (about 20% of all U.S. community hospitals) to evaluate the effects of ECT in inpatients with recurrent major depression.

A total of 9.4% of patients diagnosed with recurrent major depression received ECT in 1993. These patients tended to be older, white, Medicare beneficiaries, have more secondary medical diagnoses, live in more affluent areas, and live in eastern and midwestern states. Minorities, Medicaid patients, and patients with secondary substance abuse disorders were less likely to receive ECT. Hospitalizations with ECT were more costly than those without ECT. However, after controlling for demographic, diagnostic, and hospital factors, ECT initiated within five days of admission (vs. after five days or no ECT) resulted in significantly shorter and less costly admissions. For patients with recurrent major depression with psychotic features, prompt ECT administration resulted in an average nine-day reduction in length of stay and reduced cost by $8,619.

Comment: After consideration of patient selection factors, prompt ECT initiation results in shorter, less costly hospitalizations. However, this study did not examine clinical outcomes. An editorialist notes that additional research is needed to assess whether ECT for patients with recurrent depression is also more cost-effective than other contemporary treatments.

— J Yager

Published in Journal Watch Psychiatry March 1, 1998

Citation(s):

Olfson M et al. Use of ECT for the inpatient treatment of recurrent major depression. Am J Psychiatry 1998 Jan 155 22-29.

Salzman C. ECT, research, and professional ambivalence. Am J Psychiatry 1998 Jan 155 1-2.

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