In patients with depression, treatment with electroconvulsive therapy (ECT) may be associated with lower rates of all-cause mortality, relative risk for rehospitalization, and suicide or suicide attempts, particularly in patients with severe depression. Published in the Journal of Psychopharmacology, a cohort study on the subject was conducted in Denmark in patients identified through the Danish National Patient Registry.

The investigators sought to examine the importance of depression severity as a predictor of ECT use, as well as the risk for mortality, rehospitalization, and suicidal behavior, in a nationwide sample of patients with a first-time hospital diagnosis of major depression. A cohort of 92,895 patients who received a diagnosis of single or recurrent depression between 2005 and 2016 was followed for use of ECT and adverse outcomes.

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Overall, 5.4% (n=5004) of patients were treated with ECT. The strongest predictor of ECT was depression severity. In fact, ECT was used more often in patients age >70 years of age and those who were better educated or married. In contrast, comorbid alcohol abuse and a history of prior stroke at study entry were associated with a lower rate of ECT use. 

Furthermore, the use of ECT was linked to lower rates of mortality in patients. The adjusted hazard ratio (HR) for the association between ECT and suicide in patients with mild depression was 6.99 (95% CI, 3.30-14.43) compared with an HR of 1.10 (95% CI, 0.55-2.20) in patients with severe depression and psychotic symptoms. A similar pattern was observed for emergency contacts and suicidal behavior.

A major strength of the study is the use of nationwide population-based registers in a country — Denmark — with free access to health care, thus providing the researchers with a large, relatively unselected cohort of patients.

The investigators concluded that ECT is an important treatment for patients with severe depression, noting that ECT has been linked to significant health benefits.

Reference

Jørgensen MB, Rozing MP, Kellner CH, Osler M. Electroconvulsive therapy, depression severity and mortality: data from the Danish National Patient Registry [published online January 7, 2020]. J Psychopharmacol. doi:10.1177/0269881119895518