A new study supports the medical safety of electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a medically safe intervention for mental health, according to a new study led by CAMH researcher Dr. Tyler Kaster, as part of his doctoral studies at the ICES and the University of Toronto. The study was published today in the journal Lancet psychiatry, and is one of the largest and broadest to compare the safety of ECT with standard treatment among people with depression.

Several studies over the decades have confirmed the effectiveness of ECT as a mental health intervention for people with treatment-resistant depression. Up to 80% of people with severe depression who receive ECT get remission. However, despite this success rate, only 1% of people with severe depression receive ECT, probably due to concerns about the side effects of ECT, 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 matching the propensity score examined the psychiatric records of more than 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 had ECT compared to patients who did not. It concludes that, “among people hospitalized with depression, there is no clinically significant increase in the risk of serious medical events with ECT exposure, while the risk of suicide appears to be significantly reduced. The benefits of ECT in the results of depression they may outweigh their risks in this population. “

“ECT is the simplest effective treatment we have in psychiatry for depression, “said the lead author of CAMH psychiatrist Dr. Tyler Kaster, who treats ECT patients at the Temher Center for CAMH Therapeutic Brain Stimulation.” But the prejudices and discrimination around treatment are enormous in terms of preventing people from accessing it. . “

In Canada, more than one in 9 adults (3.2 million Canadians, or 11.3%) will experience significant depression during their lifetime, at which time they will likely be prescribed antidepressants and / or psychotherapy. However, approximately one-third of these individuals will not respond to these first-line treatments and will then be diagnosed treatment-resistant depression. There are several interventions for this condition, including drug combinations, new drugs such as ketamine, and a neurostimulation treatment called repetitive transcranial magnetic stimulation (rTMS). However, when these treatments do not lead to improvement or when depression becomes very severe and leads to hospitalization, ECT is often considered the next step, as it is very effective in rapidly reducing the symptoms of depression and suicidal thinking. More information on ECT at CAMH website.

Dr. Simone Vigod, corresponding author of the study, senior assistant scientist at the ICES and head of psychiatry at the Women’s University Hospital, said the study illustrates the importance of emphasizing safety and effectiveness of ECT as an effective mental health intervention for people for whom nothing else has worked. “At Women’s College Hospital, we believe it has never been more important to support people living with mental health conditions,” Dr. Vigod added. “Doing so requires providing patients with a full spectrum of evidence-based treatments based on evidence from rigorous research. This research is in addition to the existing body of research on the safety and efficacy of ECT, which can serve as a valuable option for those with severe depression. “

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

CAMH continues to be the Canadian leader in neurostimulation treatment and treats approximately 250 patients a year with ECT. CAMH’s Temerty Center for Brain Therapeutic Intervention is one of the world’s leading centers in brain stimulation treatment, research and training. Through clinical research projects, the Temerty Center drives treatment advances through repetitive transcranial magnetic stimulation (rTMS), magnetic convulsion therapy (MST), and ECT.