Classics in ECT: Avery and Winokur On the Efficacy of ECT, 1977
"Classics in ECT" brings you this paper from 1977:
The efficacy of electroconvulsive therapy and antidepressants in depression.
Biol Psychiatry. 1977 Aug;12(4):507-23.PMID: 889984
The abstract is copied below:
Electroconvulsive therapy (ECT), antidepressants, and neither treatment were compared by reviewing 609 hospitalizations for depression from 1959 to 1969. The groups receiving ECT had a significantly (p less than 0.001) greater percentage of patient who had marked improvement or a complete response (49%) than either adequate or inadequate antidepressant therapy groups (27%) or the group which received neither ECT nor antidepressants (25%). If antidepressant failures who require ECT are included in the evaluation, the percentage total improvement with ECT (90%) is significantly (p less than 0.001) greater than the adequate (74%) or inadequate (60%) antidepressant groups, or neither treatment (60%). At the end of 7 weeks of hospitalization, 74% of the ECT group had been discharged, significantly more (p less than 0.001) than the adequate antidepressant group, 54%. Delusional depressed patients responded much more frequently to ECT.
The pdf is not here, because it seems that Biological Psychiatry is not archived prior to 1980.
This is an important study from the tricyclic (TCA) and monoamine oxidase inhibitor (MAOI) era. The high response rates speak for themselves. If anyone has access to the pdf, kindly share. Otherwise, we will need to be satisfied with the informative abstract and the knowledge that this large retrospective study is in the literature (Google says cited by 240).
David Avery remains in practice in Seattle, George Winokur died in 1996.
The below comment is from Dr. Max Fink:
ReplyDeleteAvery and Winokur June 5, 2021
George Winokur was trained at Washington University in the 1960s when Sam Guze and Eli Robins developed diagnostic criteria for 13 syndromes, including catatonia, that were published as Feighner Diagnostic Criteria. In this study of TCA, MAOI and ECT, the authors demonstrate the superior efficacy of ECT over these medications. Markedly more effective for psychotic depressed patients. It is an oft quoted report that is a strong antidote to the cries of psychologists and psychotherapists that ECT is unproven.
Using the Feighner criteria for catatonia, James Morrison at Iowa and Michael Taylor and Richard Abrams in New York City in the 1970s showed that catatonia was less prevalent in schizophrenia than in the mood disorders, liberating catatonia from its burial by Kraepelin, Bleuler and the authors of DSM-I, DSM-II, DSM-III. (DSM-IV recognized catatonia as secondary to sytemic medical disorders as well as a form of schizophrenia.)
Max Fink, MD