"One concern expressed by many considering ECT is a 'fear of death,' despite evidence suggesting ECT for depression is a medically safe procedure," Dr. Tyler Kaster of the Centre for Addiction and Mental Health in Toronto told Reuters Health by email. "Previous work had been unable to determine the effect of ECT on the risk for serious medical events separate from the underlying condition - e.g., depression - it is treating."
To learn more, Dr. Kaster and colleagues analyzed data on over 10,000 psychiatric hospitalizations for individuals with depression in Ontario, Canada. "We accounted for over 75 different variables to address the important differences between individuals who do and do not receive ECT," he said.
"Our primary finding was that there did not appear to be a clinically significant increased risk of serious medical events amongst those who received ECT compared to those who did not in the 30 days following the first ECT treatment," Dr. Kaster said. "In a secondary analysis, we also found that suicide death was significantly reduced amongst those who received ECT."
Specifically, as reported in The Lancet, in propensity score matched analyses of 5,008 patients (mean age, 57; about a third, men), the incidence of serious medical events was 0.25 per person-year in the ECT group and 0.33 per person-year in the non-ECT group (cause-specific hazard ratio, 0.78). The finding persisted even when considering suicide death as a competing risk.
Further, as Dr. Kaster noted, the risk of suicide death was significantly lower in the ECT group (five or fewer patients versus 11).
Dr. Kaster said, "The decision to pursue ECT is a complex one for patients and their loved ones that involves balancing risks and benefits of treatment. Numerous studies support the efficacy of ECT for depression and our study provides reassuring evidence regarding the safety and medical risks of ECT that can be used by individuals to make informed decisions about pursuing treatment."
A separate study published in JAMA Network Open also supports ECT for reducing suicide risk after hospitalization for depression. Dr. Axel Nordenskjöld of Orebro University Hospital in Sweden and colleagues conducted a propensity-matched registry-based study of more than 28,000 patients (mean age, 56; about 56% women). They found that ECT was significantly associated with a decreased risk of suicide in patients with psychotic features (hazard ratio, 0.20) and those ages 45 to 64 (HR, 0.54) or 65 or older (HR, 0.30), but not in those age 44 or younger (HR, 1.22).
Dr. Bradley Gaynes of the University of North Carolina at Chapel Hill, author of an editorial related to that study, told Reuters Health by email, "There are some caveats for these results. It was not possible to account for different co-interventions that might have differed between the two groups, such as the number of contacts, or outpatient follow-ups, or change in medication dose, or other forms of more active management. Some of these interventions might explain the differences seen."
"Indeed," he said, "when the authors controlled for some types of these co-interventions, such as differences in antidepressant use and treatment with lithium (which may also reduce suicide risk), there was still benefit for ECT reducing suicide risk, but the magnitude of that benefit was reduced."
"So, next research steps are to more aggressively control for these kinds of co-interventions to confirm the magnitude of the reduced suicide risk benefit."
Dr. Nordenskjöld did not respond to requests for a comment.
SOURCES:
https://bit.ly/2VcoJHG and https://bit.ly/3y8whd9 The Lancet Psychiatry, online July 12, 2021.
https://bit.ly/3x8k6M7 and https://bit.ly/3i7vfbA JAMA Network Open, online July 21, 2021.
By Marilynn Larkin
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