Use of ECT for Depression in England

Out on PubMed recently from researchers in England is this audit report:
Prescribing for moderate or severe unipolar depression in patients under the long-term care of UK adult mental health services.

Paton C, Anderson IM, Cowen PJ, Delgado O, Barnes TRE.Ther Adv Psychopharmacol. 2020 Jun 15;10:2045125320930492. doi: 10.1177/2045125320930492. eCollection 2020.PMID: 3259593
The abstract is at the above link, and copied here:

Background: A quality improvement programme addressing prescribing practice for depression was initiated by the Prescribing Observatory for Mental Health.

Methods: A baseline clinical audit against evidence-based practice standards was conducted in UK adult mental health services.

Results: A total of 55 mental health services submitted data for 2082 patients, under the care of a community psychiatric team (CMHT) for at least a year, with a diagnosis of moderate or severe unipolar depression, 54% of whom had a comorbid psychiatric diagnosis. Selective serotonin reuptake inhibitors were prescribed for 35% of the patients, other newer generation antidepressants for 60%, tricyclic antidepressants for 6% and monoamine oxidase inhibitors for <1%. The most commonly prescribed individual antidepressants were mirtazapine (33%, usually in combination with another antidepressant), venlafaxine (25%) and sertraline (21%). Patients with severe depression were more likely (p < 0.001) to be co-prescribed an antipsychotic medication, lithium, or to have received electroconvulsive therapy. There was a documented clinical review in the last year in 85%, with a symptom rating scale used in 11%. A documented comprehensive treatment history was accessible for 50% of those prescribed antidepressant medication.

Conclusion: Patients with moderate or severe depression remaining under the care of a CMHT for longer than a year are clinically complex. The failure to achieve a level of wellness allowing discharge from mental health services may be partly related to the finding that not all patients had the benefit of a systematic approach to clinical assessment and sequential testing of available evidence-based pharmacological interventions.

The pdf is here.

This is an audit of care including 2082 patients: 1142 with moderate depression, 940 with severe depression. Electroconvulsive therapy was used either in the past or currently in 30 (6%) patients with moderate depression and 71 (17%) with severe depression (p < 0.001).

These numbers are actually higher than I would have expected, since England has a history of marginalizing ECT and the NICE reports have been anything but, to ECT.
If you are interested in the details of the antidepressant medication strategies used, I recommend reading the full report. Also, some of the details of the organization of psychiatric care in the NHS, with  primary care gatekeeping, are quite interesting.