Adherence to clinical practice guidelines for using electroconvulsive therapy in elderly depressive patients

Area of Science:

• Psychiatry
• Geriatrics
• Neuroscience

Background:

• Electroconvulsive therapy (ECT) is a highly effective treatment for mood disorders, particularly major depressive episodes (MDEs) in major depressive disorder (MDD) and bipolar disorder (BD).
• Older adults (≥65 years) are a vulnerable population at increased risk for adverse drug reactions, making safe and effective treatments like ECT crucial.
• Despite its efficacy, ECT is often underutilized and neglected in clinical practice.

Purpose of the Study:

• To investigate the duration of MDEs and the number of treatment lines preceding ECT initiation in elderly patients (≥65 years).
• To analyze whether the presence of first-line indications for ECT influences the delay in treatment initiation.
• To compare these factors between patients with unipolar (MDD) and bipolar disorder (BD).

Main Methods:

• A multicenter, retrospective study involving 335 patients aged 65 years or older with MDEs treated with ECT.
• Data collection included MDE duration, number of prior treatment lines, and the presence of guideline-defined first-line indications for ECT.
• Statistical analyses were performed to compare treatment delays and characteristics between patient groups.

Main Results:

• The mean duration of MDEs before ECT was approximately 9 months, shorter in BD (7 months) than MDD (10 months).
• Chronic medical conditions prolonged MDE duration before ECT in the MDD group.
• First-line indications did not shorten MDE duration, except for prior ECT response, but did reduce the number of prior treatment lines.

Conclusions:

• Despite its established efficacy and safety in the elderly for MDEs, significant delays in initiating ECT remain.
• These delays suggest a need to optimize the integration of ECT into treatment algorithms for older adults with mood disorders.
• Further research and clinical practice improvements are warranted to ensure timely access to this vital treatment.