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Time course of response to electroconvulsive therapy in elderly depressed subjects
J H Williams1, J T O'Brien, S Cullum
1St Andrew's Hospital, Norwich, UK.
Objective:
To assess the time course of response to electroconvulsive therapy (ECT) in elderly depressed subjects. In particular, to determine whether significant antidepressant response occurs during the first few treatments.
Design:
A naturalistic study of elderly patients receiving ECT.
Setting:
Acute admission wards of a UK old age psychiatric service.
Patients:
13 consecutive inpatients aged over 65 years, meeting inclusion criteria, with a diagnosis of current major depressive episode, who were treated with ECT.
Main Outcome Measures:
Severity of depression as assessed by the Montgomery and Asberg Depression Rating Scale (MADRS), psychomotor speed as assessed by Gibson's spiral maze test (GSM) and the Kendrick digit copying test (KDCT).
Results:
The first ECT treatment reduced the mean MADRS score by 21% (p < 0.0001) and the second treatment the mean MADRS was reduced by 36% (p < 0.0001). A non-significant improvement on GSM scores was seen that paralleled improvement in the MADRS. The average number of ECT treatments needed to reduce the MADRS score by half was 3.73 +/- 1.85, though the actual number varied between 1 and 7.
Conclusions:
ECT is a highly effective treatment for depression in the elderly and significant antidepressant response can be demonstrated after only one treatment, arguing for careful mental state monitoring during treatment. However, considerable variability is seen in individual cases, implying that ECT should not be abandoned just because rapid response is not seen.