Electroconvulsive therapy effective option for severe depression
JANUARY 10, 2007
Electroconvulsive therapy (ECT) appears more effective than repetitive transcranial magnetic stimulation (rTMS) for short-term treatment of severe depression. This was the conclusion of a research study by Dr Savitha Eranti and colleagues that has been presented in the January 2007 issue of The American Journal Of Psychiatry (AJP).
The researchers found that patients who received ECT and rTMS produced remission rates of 59 percent and 17 percent, respectively. Six months later, the patients’ ratings of psychiatric symptoms remained lower in the ECT patients. The trial included 46 patients, 24 assigned to rTMS and 22 assigned to ECT.
At the end of treatment, scores on the Hamilton Depression Rating Scale had fallen by 58 percent in the ECT group and 22 percent in the rTMS group. The difference in scores between groups was statistically significant at the end of treatment but not at six months. However, differences did remain in self-rated mood measures and psychiatric symptoms overall.
All patients had been referred for ECT and continued to take their medications. rTMS was administered on a fixed schedule of 15 daily treatments but ECT continued until a response was evident. The ECT group reported fewer side effects after treatment, compared to the rTMS group. ECT can be associated with post-treatment memory problems, but the only difference in cognitive measures was a mild improvement in attention and orientation among patients who received ECT, compared with a decrease in the rTMS group.
ECT is helpful for people whose severe depression has not responded to other treatments. rTMS is nonconvulsive and requires no anesthesia, and initial randomized studies suggested that its effectiveness was similar to ECT. This study compared the two treatments under real-world conditions and over time. The authors point out that while the optimal administration of ECT has been determined over several decades, the most effective methods for rTMS are not yet known.