Decision-making Capacity for Treatment After ECT for Depression: New Study From Ireland

Out on PubMed, from investigators in Ireland, in JECT, is this study:

Decision-making Capacity for Treatment After Electroconvulsive Therapy for Depression.

Loughran O, Finnegan M, Dud I, Galligan T, Kennedy M, McLoughlin DM.J ECT. 2021 Oct 13. doi: 10.1097/YCT.0000000000000804. Online ahead of print.PMID: 34699391

The abstract is copied below:

Objectives: Depression can impair decision-making capacity (DMC) for health care decisions. However, it is unclear whether DMC improves after treatments for depression such as electroconvulsive therapy (ECT). There is limited evidence available on DMC for treatment in patients with depression referred for ECT, and it is unknown whether ECT has any impact on DMC. We hypothesized that ECT will improve DMC in severely depressed patients and that this change will be associated with reduced depressive symptom severity.

Methods: Using the MacArthur Competence Assessment Tool-Treatment, 4 abilities related to DMC were evaluated: Understanding, Appreciation, Reasoning, and Expressing a choice. This prospective study compared DMC abilities, depression severity, and cognition scores in 24 patients hospitalized with a major depressive episode before and 3 to 5 days after a course of ECT.

Results: Although Understanding scores significantly improved after ECT (P = 0.004, r = 0.41), there was no change in other abilities related to DMC or cognition scores. As expected, there was a large improvement in mood ratings after ECT, but the change in DMC abilities was not associated with change in depressive symptoms.

Conclusions: To our knowledge, this is the first study to provide data on the effects of ECT on DMC in patients with depression. Abilities related to DMC that may be affected in this group before treatment include Understanding and Reasoning. Findings indicate that DMC to consent to treatment mostly does not change after a course of ECT and some aspects can improve in patients with depression.





This is a very interesting, small study that looks at decision-making capacity (DMC) in depressed patients before, and after ECT. It introduces us to the assessment instrument, the MacArthur Competence Assessment Tool-Treatment, and the four domains of DMC.
The results of increased scores in the "understanding" domain, with stability in the others, is reassuring.
Consent and capacity issues continue to be in the spotlight with ECT, so this study is timely and helpful to have in the evidence base.
I recommend a full read to all ECT personnel interested in consent/decision-making capacity related to ECT, ~15 minutes.

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