Electroconvulsive therapy improves quality of life for at least six months

Electroconvulsive therapy (ECT) – shock treatment –improves quality of life in patients with major depression, and that improved quality of life continues for six months, according to a report in the February Journal of Affective Disorders.

The study was conducted in seven hospitals in New York City – two private psychiatric hospitals, three community hospitals and two academic medical centers, said W. Vaughn McCall, M.D., M.S., the lead author and professor and chairman of the Department of Psychiatry and Behavioral Medicine at Wake Forest University School of Medicine.

“This study adds to the accumulating evidence that ECT is associated with a net health benefit in depressed patients who attain and sustain remission,” wrote McCall and colleagues. ECT has long been known to be an effective treatment for major depression.

The results from 283 severely depressed patients at the seven New York City hospitals confirm results from an earlier study McCall did of 77 ECT patients at Wake Forest University Baptist Medical Center, a study that was published in the November 2004 issue of the British Journal of Psychiatry.

In that study, he said, “Quality of life and function are improved in ECT patients as early as two weeks after the conclusion of ECT.” In the new study, the psychiatrists said, “ECT is associated with improved health-related quality of life in the short term and the long term.” Most of the improvements were largely explained by the control of depressive symptoms, McCall said.

ECT is a treatment for severe mental illness, especially major depression, in which a brief application of electric stimulus – a shock – is used to produce a generalized seizure. Doctors administer ECT after the patient has been given both an anesthetic and a muscle relaxant.

Before the ECT treatment, the authors said, health-related quality of life was very low.

The team measured quality of life with a tool called Medical Outcomes Study Short Form before ECT, several days after ECT, and again 24 weeks later. Before the ECT treatment, the authors said, health-related quality of life was very low: for example a measure called “vitality” was 20.4, “social functioning” was 22.8, and “emotional” was 6.4. Six months later, vitality was 40.1, social functioning was 55.2 and emotional was 42.8.

“All these scales have a range of scores from 0 to 100 with 100 being fully functional and zero indicating a complete deficit,” McCall said.

Overall, at 24 weeks, 78 percent of the patients had improved quality of life. While the study did not extend beyond six months, McCall said that in earlier studies he reported improvements in quality of life persist for a year in most patients after ECT.

McCall said the evidence from the current study and his earlier ones at Wake Forest counters the argument of those who would like to severely restrict ECT.

“Some agencies have recommended that ECT be restricted in use because of perceived gaps in knowledge regarding it effects of health-related quality of life,” McCall said. He noted that the National Institute for Clinical Excellence in the United Kingdom recommended limits on ECT, pending more information, especially on the impact of ECT on quality of life.

“Our results indicate that a restrictive public policy toward ECT is not warranted on the basis of the effect of ECT on quality of life,” McCall said.

He said there were side effects to ECT. Most patients experience temporary learning difficulties for up to two weeks after ECT. Permanent memory loss of the events in the few months preceding ECT is also common, he said.