J Korean Neuropsychiatr Assoc.  2016 Aug;55(3):202-208. 10.4306/jknpa.2016.55.3.202.

Effectiveness and Safety of Electroconvulsive Therapy in Clinical Practice

• Joo SW
• Jeong HE
• Chon MW
• Joo YH
• Kim CY
• Lee JS

• KMID: 2351546
• DOI: http://doi.org/10.4306/jknpa.2016.55.3.202

Abstract

OBJECTIVES
There is little research on the practice and effectiveness of electroconvulsive therapy (ECT) in Korea. This study investigated the practice pattern, effectiveness, and safety of ECT.
METHODS
This chart review study included electronic medical records of 180 patients treated with ECT between January 2007 and December 2013 at the Asan Medical Center. Symptomatic improvement was assessed using Clinical Global Impression (CGI) scale. Treatment response was defined as CGI improvement scale score of 2 or less. Re-hospitalization was used as an indicator of recurrence. Safety was assessed by spontaneous reports from patients.
RESULTS
One hundred and eighty patients underwent 1539 sessions of modified ECT. Their most frequent diagnosis was major depressive disorder (n=74, 41.1%). The most common indication for ECT was poor response to medication (n=177, 75.3%). Treatment response rate was 66.9% in acute phase group and 63.8% in the patients with poor response to medication. The recurrence rate at six months after the end of the course was 29.6%. Memory impairment or amnesia was the most common adverse effect.
CONCLUSION
There was a remarkable improvement following ECT in patients who responded poorly to medications, and most adverse effects were tolerable and temporary. The present study suggests that ECT could be a useful treatment option.

Keyword

Electroconvulsive therapy; Effectiveness; Survey; Safety

MeSH Terms

Amnesia
Chungcheongnam-do
Depressive Disorder, Major
Diagnosis
Electroconvulsive Therapy*
Electronic Health Records
Humans
Korea
Memory
Recurrence

Figure

• 

  Fig. 1 Kaplan-Meier curves showing proportion of acute phase group who had a response to ECT, without continuation or maintenance ECT (n=145) : (A) whole group, (B) according to diagnosis. NOS : Not otherwise specified, ECT : Electroconvulsive therapy

Reference

1. Accornero F. An eyewitness account of the discovery of electroshock. Convuls Ther. 1988; 4:40–49.

2. Bini L. Professor Bini's notes on the first electro-shock experiment. Convuls Ther. 1995; 11:260–261.

3. Lambe S, Mogg A, Eranti S, Pluck G, Hastilow S, McLoughlin DM. Trends in use of electroconvulsive therapy in South London from 1949 to 2006. J ECT. 2014; 30:309–314.

4. Fink M. What was learned: studies by the consortium for research in ECT (CORE) 1997-2011. Acta Psychiatr Scand. 2014; 129:417–426.

5. Goldberg JF, Truman CJ. Antidepressant-induced mania: an overview of current controversies. Bipolar Disord. 2003; 5:407–420.

6. Price LH, Tyrka AR. Adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007; 357:614.

7. Hasan A, Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry. 2012; 13:318–378.

8. Kellner CH, Greenberg RM, Murrough JW, Bryson EO, Briggs MC, Pasculli RM. ECT in treatment-resistant depression. Am J Psychiatry. 2012; 169:1238–1244.

9. Pompili M, Lester D, Dominici G, Longo L, Marconi G, Forte A, et al. Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res. 2013; 146:1–9.

10. Leiknes KA, Jarosh-von Schweder L, Høie B. Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav. 2012; 2:283–344.

11. Vamos M. The cognitive side effects of modern ECT: patient experience or objective measurement? J ECT. 2008; 24:18–24.

12. Prudic J. Strategies to minimize cognitive side effects with ECT: aspects of ECT technique. J ECT. 2008; 24:46–51.

13. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Philadelphia: Wolters Kluwer;2014.

14. Eranti S, Mogg A, Pluck G, Landau S, Purvis R, Brown RG, et al. A randomized, controlled trial with 6-month follow-up of repetitive transcranial magnetic stimulation and electroconvulsive therapy for severe depression. Am J Psychiatry. 2007; 164:73–81.

15. Meron D, Hedger N, Garner M, Baldwin DS. Transcranial direct current stimulation (tDCS) in the treatment of depression: systematic review and meta-analysis of efficacy and tolerability. Neurosci Biobehav Rev. 2015; 57:46–62.

16. American Psychiatric Association. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: a task force report of the American Psychiatric Association. 2nd ed. Washington, DC: American Psychiatric Press;2001.

17. Ellis P. Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Depression. Australian and New Zealand clinical practice guidelines for the treatment of depression. Aust N Z J Psychiatry. 2004; 38:389–407.

18. Seo JS, Song HR, Lee HB, Park YM, Hong JW, Kim W, et al. The Korean medication algorithm for depressive disorder: second revision. J Affect Disord. 2014; 167:312–321.

19. Vera I, Sanz-Fuentenebro J, Urretavizcaya M, Verdura E, Soria V, Martínez-Amorós E, et al. Electroconvulsive therapy practice in Spain: a national survey. J ECT. 2016; 32:55–61.

20. Sienaert P, Falconieri T, Obbels J, van den Ameele H, Bouckaert F. Improving practice in electroconvulsive therapy: a nationwide survey in Belgium. J ECT. 2016; 32:29–32.

21. Nordanskog P, Hultén M, Landén M, Lundberg J, von Knorring L, Nordenskjöld A. Electroconvulsive therapy in Sweden 2013: Data From the National Quality Register for ECT. J ECT. 2015; 31:263–267.

22. Martin BA, Delva NJ, Graf P, Gosselin C, Enns MW, Gilron I, et al. Delivery of electroconvulsive therapy in Canada: a first national survey report on usage, treatment practice, and facilities. J ECT. 2015; 31:119–124.

23. Kim KT, Yoon DJ, Shin YH, Bahn GH, Yum TH. A view of Korean psychiatrists about electroconvulsive therapy. J Korean Neuropsychiatr Assoc. 2001; 40:1072–1089.

24. Choi YM, Jung SW, Kim YT, Kim HC. Clinical effectiveness of electroconvulsive therapy in a university hospital setting. J Korean Neuropsychiatr Assoc. 2015; 54:330–337.

25. Park S, Lee MK. Successful electroconvulsive therapy and improvement of negative symptoms in refractory schizophrenia with clozapine-induced seizures: a case report. Psychiatr Danub. 2014; 26:360–362.

26. Roh J, Kang MH, Kim CE, Lee JS, Bae JN. Electroconvulsive therapy for major depressive disorder in a patient with a permanent skull defect: a case report. Asia Pac Psychiatry. 2014; 6:454–457.

27. Sackeim H, Decina P, Prohovnik I, Malitz S. Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments. Arch Gen Psychiatry. 1987; 44:355–360.

28. Beale MD. Stimulus dosing methods in electroconvulsive therapy. Psychiatr Ann. 1998; 28:510–512.

29. Frukacz A, Mitchell P. Fitting the treatment to the patient: recent advances in the practice of electroconvulsive therapy. Aust N Z J Psychiatry. 1995; 29:484–491.

30. Chanpattana W, Kramer BA, Kunigiri G, Gangadhar BN, Kitphati R, Andrade C. A survey of the practice of electroconvulsive therapy in Asia. J ECT. 2010; 26:5–10.

31. Connolly BS, Lang AE. Pharmacological treatment of Parkinson disease: a review. JAMA. 2014; 311:1670–1683.

32. Ueda S, Koyama K, Okubo Y. Marked improvement of psychotic symptoms after electroconvulsive therapy in Parkinson disease. J ECT. 2010; 26:111–115.

33. Usui C, Hatta K, Doi N, Kubo S, Kamigaichi R, Nakanishi A, et al. Improvements in both psychosis and motor signs in Parkinson’s disease, and changes in regional cerebral blood flow after electroconvulsive therapy. Prog Neuropsychopharmacol Biol Psychiatry. 2011; 35:1704–1708.

34. Berg JE. Electroconvulsive treatment of a patient with Parkinson’s disease and moderate depression. Ment Illn. 2011; 3:e3.

35. Cumper SK, Ahle GM, Liebman LS, Kellner CH. Electroconvulsive therapy (ECT) in Parkinson’s disease: ECS and dopamine enhancement. J ECT. 2014; 30:122–124.

36. Muralidharan K, Thimmaiah R, Chakraborty V, Jain S. Bifrontal ECT for drug-induced psychosis in Parkinson’s disease. Indian J Psychiatry. 2011; 53:156–158.

37. Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. Am J Psychiatry. 2015; 172:52–58.

38. Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001; 285:1299–1307.

39. Kellner CH, Knapp RG, Petrides G, Rummans TA, Husain MM, Rasmussen K, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry. 2006; 63:1337–1344.

40. Husain MM, Rush AJ, Fink M, Knapp R, Petrides G, Rummans T, et al. Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report. J Clin Psychiatry. 2004; 65:485–491.

41. Brodaty H, Berle D, Hickie I, Mason C. “Side effects” of ECT are mainly depressive phenomena and are independent of age. J Affect Disord. 2001; 66:237–245.