Empirical study on an inpatient psychogeriatric unit: biological treatment in patients with depressive illness

A study of 112 psychogeriatric admissions identified seventy patients sufficiently depressed to require biologic treatment. Twenty-four patients completed a primary treatment trial with TCA's and seventeen with ECT. ECT proved to be more effective, (81.4% versus 62.5%), even though overtly psychotic and medically unstable patients preferentially received this treatment. The ECT response rate is comparable to other reports of its efficacy in the treatment of delusional depression. A higher morbidity rate of 27 percent in the TCA-treated group was observed. The authors conclude that ECT is a highly beneficial treatment modality for the carefully selected elderly patient with major depressive illness. They found that a higher number of ECT treatments than expected were required in their psychogeriatric patients, but did not find a higher morbidity other than increased confusion with more treatments. Careful repeated assessment of response to treatment combined with readiness for assertiveness, in spite of the advanced age of the patient, seem to be indicated. Conversely, excessive hesitance when caring for the elderly patient may lead to a premature termination of treatment, causing the patient to remain in a chronic mentally compromised state.