Electroconvulsive Therapy More Effective Than Medication in Depression

Laurie Barclay, MD

March 06, 2003

March 6, 2003 — Electroconvulsive therapy (ECT) is more effective than medications for the treatment of depression, according to the results of a meta-analysis published in the March 8 issue of The Lancet. Bilateral ECT was better than unilateral ECT, and high-dose was better than low dose.

"There is a reasonable evidence base for the use of ECT: it does not rest simply on anecdote, habit, and tradition," write John R. Geddes, from the University of Oxford in the U.K., and colleagues. "The trials that have been done reflect concerns that were uppermost at the time. In the 1970s, this concern was efficacy of electroshock per se, more recently it has been dose and site of shock administration."

This meta-analysis reviewed 73 randomized trials comparing ECT with sham ECT, ECT with drug therapy, bilateral ECT with unilateral ECT, and high-dose ECT with low-dose ECT. Assessment outcomes included decrease in depressive symptoms after therapy, symptom status at six-month follow-up, effect on cognitive function, and mortality.

Based on six trials involving 256 patients, real ECT was significantly more effective than simulated ECT. In 18 trials enrolling 1,144 subjects, ECT was significantly more effective than pharmacotherapy. Bilateral ECT was more effective than unilateral ECT in 22 trials involving 1,408 subjects.

"ECT remains an important treatment option for the management of severe depression," the authors write, while recommending adherence to current practice standards for optimal results. "It is clear that any attempt to simplify our findings to one strategy for all clinical situations (one size fits all) will be unhelpful."

Lancet. 2003;361:799-808

Reviewed by Gary D. Vogin, MD