Electroconvulsive Therapy: A Scotland-Wide Naturalistic Study of 4826 Treatment Episodes.
Out on PubMed, from investigators in Scotland, is this paper:
Electroconvulsive Therapy: A Scotland-Wide Naturalistic Study of 4826 Treatment Episodes.
Biol Psychiatry Glob Open Sci. 2024 Dec 16;5(2):100434. doi: 10.1016/j.bpsgos.2024.100434. eCollection 2025 Mar.PMID: 39926701
The abstract is copied below:
Background: Electroconvulsive therapy (ECT) is an effective treatment option for several psychiatric disorders, including treatment-resistant depression, but there are concerns about potential adverse effects, particularly on cognition. This study describes ECT response and side effects in the Scottish ECT Audit Network.
Methods: Data collected from 4826 treatment episodes includes pre-ECT and post-ECT illness severity scores (Clinical Global Impression-Severity [CGI-S] and Montgomery-Åsberg Depression Rating Scale [MADRS]), diagnosis, age, sex, consent status, treatment year, treatment frequency, dose, and reported side effects. Descriptive statistics were used to assess the response to ECT by diagnosis, and logistic regression was used to investigate which factors influenced ECT response and side-effect occurrence.
Results: CGI-S scale scores were reduced after ECT in all diagnoses. For patients with depression or bipolar depression, MADRS scores were also reduced after ECT. The most common side effect was headaches (29%). Increased age and increased CGI-S scores were significantly associated (multiple-testing corrected p < .05) with better treatment response and more cognitive side effects.
Conclusions: In a large observational outcome study of ECT, ECT appears to be effective (measured by reduction in CGI-S or MADRS scores) across a range of psychiatric diagnoses. Furthermore, increased age and increased illness severity scores at entry were the variables most significantly associated with treatment response and cognitive side effects.
Keywords: Clinical Global Index-Severity Scale; Depression; Electroconvulsive therapy; Montgomery–Åsberg Depression Rating Scale; Response; Side effects.
Plain language summary
We used the SEAN (Scottish Electroconvulsive Therapy [ECT] Audit Network) data to investigate whether ECT is effective. The SEAN was established in 1996 with the aim of improving ECT practice across Scotland to ensure safe, effective, patient-centered care. We used 11 years of data (∼4800 episodes of treatment) to explore the effectiveness of ECT and the frequency of side effects across 8 common mental illnesses. We also explored which individual or treatment factors contributed to the effectiveness of ECT and reported side effects. We demonstrated that ECT was effective for depression, schizophrenia, schizoaffective disorder, bipolar disorder, mania, mixed affective disorders, personality disorder, and postpartum disorder. Headaches were reported in 29% of episodes during the treatment course, but other side effects such as manic switch and prolonged seizure were rare (<2%). Female sex and increased symptom severity were significantly associated with effectiveness and cognitive side effects. Cognitive and memory problems may be reported in several psychiatric disorders such as severe depression and bipolar depression, with longer duration of illness being associated with more cognitive problems. Under the current guidelines, it is likely that the individuals included in this study will have tried multiple medications, over several years, before being offered ECT. Therefore, the side effects should be considered in the context of prolonged, severe, treatment-resistant illness.
The article is here.
And from the text:
This is a very interesting, possibly even important dataset, no question. So the authors deserve big kudos for that.
But that won't stop me from nit-picking:
80% response rate and "ECT APPEARS to be effective"! Puh-leeeze!
And this is really like the mouse that roared: ten years of data from an entire nation, when the same amount of ECT would be done in a busy US ECT service in 6-9 months. But they did organize themselves to collect the data, so that earns even more kudos.
The severity and age predictors are nicely confirmatory and diagnostic spread very informative, bolstering the evidence base for ECT in bipolar disorder.
Oh, and IMO it's time to drop the overly conservative 2003 UK ECT Review Group as the main ECT reference, hard as that habit may be to break...
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