ECT and old age psychiatry

The editorial on electroconvulsive therapy (ECT) by Eranti & McLoughlin (2003) describes the current status of ECT as a treatment option. They have noted that the use of ECT is declining and also highlight that in a study from Edinburgh (Glen & Scott, 1999) a reduction in the number of recipients aged 18-65 was noted. While discussing the future of the ECT clinic, they raise concerns about how this reduced use could lessen clinical interest and how this could, in turn, affect future psychiatric trainees with respect to obtaining experience in ECT. They rightly highlight the need for this treatment option to be readily available for our patient group.

In this context, I want to report some of the findings from a study my colleagues and I presented as a poster at the annual meeting of the Royal College of Psychiatrists in Edinburgh in July 2000. The study looked at trends in ECT usage in the busy ECT clinic at the Royal London (St Clement's) Hospital. It was a retrospective, chart-based study, covering a 3-year period during 1996-1999. Demographic and clinical data, which included response to ECT, were noted. There was a reduction in the number of patients who received ECT from 25 (171 total ECT episodes) in the year 1996/1997 to 12 (113 ECT episodes) in the year 1998/1999. Of the patients who received ECT, 70% were women and about 65% of the sample were aged above 60 years. A good response was noted in 45% of patients and, of this group, 70% were aged more than 60 years. The most common indication was depression and most of the findings of the practice of ECT at the unit were in keeping with national trends reported by the Department of Health (1999). Over this 3-year period, consultant groups in the unit remained largely unchanged.

Concluding from this study, I feel that ECT is more commonly used in treating older people with depression. Availability of newer antidepressants and other treatment modalities, as highlighted by Eranti & McLoughlin (2003), could be some of the reasons why there is a decline in the number of patients under 65 who receive ECT. Furthermore, the limited response to ECT in the subjects of our study could be due to the fact that these patients had been treatment-resistant. On the other hand, in the case of older people suffering from severe depression, there are other factors that tilt the treatment options towards ECT. Factors such as physical frailty, propensity to develop side-effects from anti-depressants, and the serious effects of dehydration and weight loss (as a result of severe depression) make it imperative that depression is controlled rapidly.

I feel that in the future, it will be old age psychiatrists who will be using ECT more commonly as a treatment option for depression. Old age psychiatrists could take a leading role in ensuring that psychiatric trainees have the opportunity to obtain experience in ECT. The effective (albeit reduced) use of ECT resulting in good clinical outcomes will ensure that clinical interest in this treatment modality is maintained.