Out on PubMed, from the Harvard ECT group, is this study:
The effects of electroconvulsive therapy on depression and Suicidality in transgender and gender diverse individuals.
Luccarelli J, Crall C, Hart KL, Seiner SJ, Henry ME.Gen Hosp Psychiatry. 2021 Aug 14:S0163-8343(21)00115-8. doi: 10.1016/j.genhosppsych.2021.08.006. Online ahead of print.PMID: 34518020
A total of 19 patients met inclusion criteria. Mean age was 24.1 ± 5.5 years, and primary clinical diagnoses were major depressive disorder (13; 68.4%), bipolar disorder (5; 26.3%), and other (1; 5.3) (Table S1). Patients self-reported a range of gender identities, with 9 (47.3%) identifying as gender non-binary (Table S2). At baseline patients had severe-range depression on the QIDS, with a mean score of 17.0 ± 4.9. Median BASIS-24 SI subscale was 1.25 (IQR 0.42 to 3.00) (Fig. 1). At treatment #5, mean QIDS was 11.2 ± 4.5, with a median SI subscale of 0.58 (IQR 0.00 to 1.79). At treatment #10, 14 patients continued in ECT; mean QIDS was 9.6 ± 4.8, and median BASIS24 SI subscale was 0.50 (IQR 0.00 to 1.46).
Looking at the individual trajectories of patients, 16 of 19 patients had an improvement in QIDS score between baseline and the time of last follow-up, while the remaining 3 had unchanged QIDS. For suicidality, 10 of 19 patients had lower BASIS-24 self-harm subscale at the time of last treatment, while 4 remain unchanged and 5 had worsened (Fig. 1). Literature in ECT in TGD patients is sparse, with the only prior reports focusing on transgender patients specifically, and cumulatively reporting on only 9 patients [5–7]. In addition to being the largest case series yet reported, this study includes patients with gender identities besides transgender. Among our 19 TGD patients, ECT was associated with a decrease in depressive symptoms as measured by the QIDS. The magnitude of this improvement (from a baseline score of 17.0 ± 4.9 to 9.6 ± 4.8 following treatment #10) is similar to the magnitude of improvement seen among all 424 patients aged 30 and younger treated at our study site, where mean QIDS reduced from 17.0 ± 4.9 to 10.3 ± 5.3 over 10 ECT treatments [8]. There is clear evidence that TGD individuals suffer from higher rates of suicidal ideation and non-suicidal self-injury relative to cisgender individuals [9]. At present there are no randomized controlled trials of interventions to reduce SI in the TGD population, and limited evidence in general for pharmacological strategies to reduce suicide generally [10]. The results of this study suggest that TGD patients with significant depression and SI may have improvement in their suicidal thinking when treated with ECT, although notably reduction in SI occurred in only 10 of 19 patients in this sample, and SI actually worsened in 5 patients despite consistent improvement in depressive symptoms.
Psychiatry has a long and complicated history with sexual orientation and gender expression, some of which shamefully involved aversive
treatment, including electric shocks, in an attempt to change sexual
identity. The legacy of this past may have ongoing effects on the
perception of ECT. In contrast to these purposely aversive methods,
modern ECT is a safe and effective treatment for underlying depression
without any attempt to modify gender identity. These results support the
idea that ECT is an effective treatment of depressive disorders regardless of the gender identity of the patient receiving treatment.
Limitations of this study include its retrospective observational nature without control group, which prevents discussion of alternative
treatment methodologies. Additionally, the one question used to assess
gender identity in this study is suboptimal, and a better strategy would
include two questions asking about sex assigned at birth and present
gender identity [11]. It is likely that the methodology used here
significantly undercounts transgender individuals, who are likely to
select the sex corresponding to their gender identity and thus would not
be identified in this sample.
This is an interesting retrospective chart review study from the Harvard group showing mostly expected results of improved depression ratings, but slightly disappointing (still helpful) results on suicidality after ECT in transgender and gender diverse patients. Kudos to the authors for shedding light on this vulnerable and oft-neglected population.
Worth a full read, ~8 minutes.
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