New study supports medical safety of electroconvulsive therapy (ECT)

According to a new study conducted by CAMH researcher Dr. Tyler Kaster as part of his doctoral studies at ICES and the University of Toronto, electroconvulsive therapy (ECT) is a medically safe intervention in mental health. The study was published today in the journal The Lancet Psychiatry, and is among the largest and most comprehensive to compare the safety of ECT with standard treatment in people with depression.

Numerous studies spanning decades have confirmed the effectiveness of ECT as a mental health intervention for people with treatment-resistant depression. Up to 80 percent of people with severe depression who receive ECT go into remission. However, despite this success rate, only one percent of people with severe depression have ever received ECT, possibly due to concerns about ECT side effects such as cognitive and medical complications.

This study, entitled Risk of serious medical events in patients with depression treated with electroconvulsive therapy: a retrospective cohort study with a propensity score, reviewed the psychiatric records of over 10,000 patients in Ontario whose depression was severe enough to require at least three days of hospitalization, and compared the risk of medical hospitalization or death within 30 days for patients who received ECT compared to patients who did not. He concludes that, “among people hospitalized for depression, there is no clinically significant increase in serious medical events with exposure to ECT, while the risk of suicide appears to be significantly reduced. The benefits of ECT on depression outcomes may outweigh its risks in this population. ”

“ECT is the most effective treatment we have in psychiatry for depression,” said lead author, CAMH psychiatrist Dr. Tyler Kaster, who treats ECT patients at CAMH’s Temerty Center for Stimulation. cerebral therapeutic. “But the stigma and discrimination around treatment is huge in terms of preventing people from accessing it.”

In Canada, more than one in nine adults (3.2 million Canadians or 11.3 percent) will experience major depression in their lifetime, at which time they will most likely be prescribed antidepressants and / or psychotherapy. However, about a third of these people will not respond to these first-line treatments and will then be diagnosed with treatment-resistant depression. There are a number of interventions for this condition, including combinations of drugs, new drugs like ketamine, and a neurostimulation treatment called repetitive transcranial magnetic stimulation (rTMS). However, when these treatments do not improve or when depression becomes very severe leading to hospitalization, ECT is often considered the next step as it is very effective in quickly reducing symptoms of depression and suicidal thoughts. . Learn more about ECT on the CAMH website.

Corresponding study author Dr Simone Vigod, Senior Associate Scientist at ICES and Chief of Psychiatry at Women’s College Hospital, said the study illustrates the importance of emphasizing the safety and effectiveness of the drug. ‘ECT as an effective mental health intervention for people for whom nothing worked. “At Women’s College Hospital, we believe that supporting people living with mental health issues has never been more important,” added Dr. Vigod. “To do this, we need to provide patients with a full range of treatments based on rigorous scientific evidence. This investigation adds to the existing body of research on the safety and efficacy of ECT, which may be a valuable option for people with severe depression. . “

Dr. Kaster believes that the lingering fear associated with ECT is a reflection of the overall level of prejudice and discrimination that continues to persist with regard to mental illness itself.

CAMH continues to be Canada’s leader in the delivery of neurostimulation therapy and treats approximately 250 patients per year with ECT. CAMH’s Temerty Center for Therapeutic Brain Intervention is one of the world’s leading centers for brain stimulation treatment, research and training. Through clinical research projects, the Temerty Center is advancing treatments using repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (STD) and ECT.

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About the Center for Addiction and Mental Health (CAMH)

CAMH is the largest mental health and addictions teaching hospital in Canada and a world-class center for mental health and addiction research. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of those affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto and is a collaborating center of the Pan American Health Organization and the World Health Organization. For more information, please visit camh.ca or follow @CAMHnews on Twitter.

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