A cohort study provides further data to support the benefit of electroconvulsive therapy (ECT) for suicide risk reduction in people with severe depression. Although ECT is indicated by the American Psychiatric Association for patients with severe depression — including those with psychosis, catatonia, or at high suicide risk — data are lacking on its benefit for lowering suicide risk.

To add to the data pool, researchers conducted a cohort study using data from Swedish national registers. The study, the results of which were published in JAMA Psychiatry, included 28,557 patients hospitalized for depression; 6412 patients received ECT. The researchers reported that ECT administrated approximately 3 times per week was associated with decreased suicide risk within 12 months compared with no ECT — 1.1% of patients receiving ECT and 1.6% who did not receive ECT died by suicide within those 12 months. The data also showed suicide to occur within 3 months in .4% of the ECT-receiving group and .7% of the non-ECT group, although this was not found to be statistically significant. The researchers found a greater association between ECT and decreased suicide risk in older age groups than in younger age groups.

Compared with the non-ECT group, those in the cohort who received ECT were more likely to have severe depression or severe depression with psychosis. Therefore, the severity of depression may have been higher in the ECT group. The ECT group also had more inpatient episodes than the non-ECT group.

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Nonetheless, “this study supports the continued use of ECT to prevent suicide

among inpatients with severe depression, especially older patients and patients with psychotic depression,” the researchers concluded.

Disclosure: One study author declared an affiliation with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Rönnqvist I, Nilsson FK, Nordenskjöld A. Electroconvulsive therapy and the risk of suicide in hospitalized patients with major depressive disorder. JAMA Netw Open. 2021;4(7):e2116589. doi:10.1001/jamanetworkopen.2021.16589