Classics in ECT: Huge Retrospective Study from the Iowa Group, 1987

"Classics in ECT" brings you this study from University of Iowa researchers in 1987:

The treatment of depression: electroconvulsive therapy v antidepressants: a naturalistic evaluation of 1,495 patients.

Black DW, Winokur G, Nasrallah A.Compr Psychiatry. 1987 Mar-Apr;28(2):169-82. doi: 10.1016/0010-440x(87)90082-4.PMID: 3829660

The pdf is here.

CONCLUSION

Our study reports important findings relating to the in-hospital treatment of acute

depression. ECT resulted in a significantly greater percentage of patients obtaining

marked improvement at discharge compared with adequate antidepressants, inadequate

antidepressants, and neither treatment. This difference was consistent for

most variables investigated, though it must be conceded that the ECT group

differed from the other groups and may not be fully comparable to them. The study

gives additional support for the use of ECT in the treatment of schizodepression and

it patients with mood incongruent delusions. The study also suggests that those with

secondary depression do not respond as well to biologic therapy as do those with

primary depression. Finally, the study demonstrates that unilateral and bilateral

treatments in depression are equivalent. Psychosis per se was not a predictor of

outcome for ECT.

Despite ongoing controversies about ECT, it remains a valid treatment option in

the psychiatrist’s armamentarium, particularly for those patients not responding to

medication. As unilateral and bilateral treatments were equally effective, and

bilateral treatments are associated with significantly more cognitive dysfunction

post-ECT,*’ we believe unilateral treatments should be used.

Once more, ECT is shown to be significantly more effective than antidepressants

in the treatment of the hospitalized depressive. No study has ever shown medication

to be superior to ECT. We hope that this and other studies will encourage more

sophisticated research in the use of ECT.

By any measure, this is a huge paper, with 448 patients in the ECT group. And this retrospective chart review was done long before the age of the EMR! Without getting into the nitty gritty of the results, suffice it to say that ECT way outperformed antidepressant medication, and worked best in patients with more clearly "biological" illness, no surprise.

It is helpful for us to be reminded of these compelling data, when certain (unnamed) people claim there are no good data about the efficacy of ECT.

This post also serves to remind us of the powerhouse research group at the University of Iowa College of Medicine Department of Psychiatry in Iowa City in the late 20th century.

Donald Black remains an active contributor to the psychiatric literature, but with few recent ECT citations.

This paper is so well presented, and covers so many issues still relevant today, that it deserves a full read (~25 minutes).