ECT as the "Gold Standard": New Editorial

Out on PubMed is this editorial:

Electroconvulsive Therapy: Still The Gold Standard for Highly Treatment-Resistant Mood Disorders.

Goldberg JF.CNS Spectr. 2021 Feb 1:1-7. doi: 10.1017/S1092852921000110. Online ahead of print.PMID: 33517939
The pdf is here.
And from the text:
As the progenitor of newer modalities of brain stimulation, ECT is neither experimental nor innovative. It has long been regarded as an established gold standard treatment for severe and/or treatment-resistant mood and psychotic disorders. In major depression, ECT exerts a large effect size and superiority to pharmacotherapy (effect size ̴0.80). It is demonstrably more effective than antidepressant pharmacotherapy for reducing suicide attempts or completions. And despite transient retrograde amnestic effects, ECT improves verbal memory and other elements of cognitive dysfunction associated with treatment-resistant depression.

...For practitioners who routinely consult on severe, pan-refractory mood disorders, there is little
basis from which to instill hope if one wipes ECT off the slate of viable treatment options. As the field continues to explore newer experimental therapies, current and future efforts will both likely benefit more from retaining existing therapies with known large effects, rather than discarding them simply
based on their vintage.

From noted bipolar expert clinician and academic, Joe Goldberg, this is an articulate and cogent assessment of the unique place of ECT in the treatment armamentarium of mood disorders. He explains why placebo-controlled ECT trials are both unnecessary and infeasible, and chides psychopharmacologists who resort to "idiosyncratic" medication combinations rather than ECT.
This editorial is a companion to the Catteneo et al. commentary, The shocking attitude towards ECT in Italy, in the same issue of CNS Spectrums, and previously discussed on this blog on December 15th, 2020.
Dr. Goldberg's piece is definitely worth a full and careful read (~5 minutes).
 


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