38 of 50 patients refused randomisation beforehand because of fear of electroconvulsive therapy (ECT). An in depth interview showed that fear of brain damage by ECT played a major role. This recently published study was a feasibility study testing the efficacy and safety of ECT, prescribed in an earlier phase of treatment than last resort. This study would test the efficacy of ECT versus nortrityline among depressed elderly (> 59 years) who had not responded to sertraline, a selective serotonin reuptake inhibitor (SSRI).
In the Netherlands and most other European countries ECT remains underused and practised mostly as a last resort treatment. Especially depressed elderly could benefit from ECT in an earlier phase since delay may worsen their situation and outcome. Elderly who refuse to drink are at greater risk compared to adults, elderly usually have somatic comorbidity, elderly have more different drugs for somatic illness subscribed with dangers of interaction with antidepressants, elderly usually do not tolerate antidepressant due to side effects. All reasons why ECT might be a safer and more efficacious alternative. From retrospective studies efficacy of ECT in the depressed elderly are promising. From these studies it is expected that elderly might benefit more from ECT than adults.
The wrong assumption that ECT causes brain damage might be a vestige of the seventy’s and the dark period of the anti psychiatry in the Netherlands in that same period. They probably still have the wrong scene from one flew over the cuckoo’s nest in their head, the scene after the lobotomy which most people confuse with the result of ECT. Moreover the practice of ECT in that movie was how it was performed in early the 30’s of the previous century. Due to this lack of knowledge a efficacious treatment is underused in this group.
ECT in the treatment of depressed elderly: lessons from a terminated clinical trial
M. L. Stek, F. B. van der Wurff, B. M. J. Uitdehaag, A. T. F. Beekman, W. J. G. Hoogendijk
Department of Psychiatry, Vrije Universiteit/VuMC and GGZ-Buitenamstel, Amsterdam, The Netherlands
Department of Clinical Epidemiology and Biostatistics, Vrije Universiteit/VuMC, Amsterdam, The Netherlands