IS ELECTROCONVULSIVE THERAPY ANY MORE EFFECTIVE THAN SIMULATED ELECTROCONVULSIVE THERAPY IN TREATMENT-RESISTANT DEPRESSION?

Background: Electroconvulsive therapy (ECT) fell out of favour towards the end of the 20th century with the advent of effective and well-tolerated antidepressants. It is now experiencing somewhat of a ‘renaissance’ in England, with an 11 percent increase in the number of ECT treatments carried out in 2015-16 compared with 2012-13, which represents approximately 2,000 additional treatments. Aims: This paper seeks to examine clinical trials comparing the efficacy of real ECT with simulated ECT in treatment-resistant depression (TRD) to determine whether the resurgence of ECT in recent years is justified. Methods: A PubMed search was performed to identify clinical trials comparing real ECT with simulated ECT. 6 trials met the inclusion criteria. These were then analysed, and their methodology assessed. Results: 5 out of the 6 trials found real ECT to have a greater antidepressant effect than simulated ECT. The trial that showed no significant difference used a unilateral electrode placement. Analysis revealed significant weaknesses in the trials. Conclusions: There is clear evidence that real ECT has a greater antidepressant effect than simulated ECT when a bilateral electrode placement is used, despite the weaknesses identified in the trials. Continued use of ECT to treat TRD in England and other countries should be encouraged. Further research is needed to better understand its mechanism of action and refine the techniques used