A large-scale review of previous studies suggests electroconvulsive therapy is an effective short-term treatment for depression.

ECT has been around since the 1930s, but doctors still hold a wide range of opinions on its effectiveness and safety. While some believe the treatment is ineffective and can lead to brain damage, others feel it is perfectly safe and the best treatment currently available in psychiatry. The result has been substantial geographical differences in the use of the treatment.

Researchers from Oxford University searched the medical literature for studies done over the years on ECT. Specifically, they collected research comparing ECT with a sham ECT treatment, ECT with pharmacotherapy, and different forms of ECT with each other. All patients suffered from depression. The review included 73 studies.

Results showed a significant benefit of ECT over the sham treatment and pharmacotherapy. In the comparison of different forms of ECT, bilateral ECT was more effective than unipolar ECT and high-dose ECT was more effective than low-dose ECT.

The analysis also showed, however, an increased risk for cognitive impairments in patients treated with ECT. Patients who received treatments three times a week had greater impairments than those receiving treatments twice a week. The cognitive impairments associated with ECT were mainly limited to changes in memory, such as temporary amnesia.

The investigators conclude ECT should be delivered only in centres with staff qualified to deliver the treatment. Patients should be informed about the risks and benefits of the procedure.

SOURCE: The Lancet, 2003;361:799-808