Title: Role of Electroconvulsive Therapy in Patients with Severe Depression
Authors: Nikhil S Gupta, Nilesh M Naphade, Jyoti V Shetty
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.24
Abstract
Introduction: Depression is the leading global cause of disability and approximately, 350 million people suffer from depression worldwide. Despite the availability of numerous psychopharmacological treatments, evidence indicates that only 60–70% of persons who tolerate antidepressants will respond to first-line drug therapy for major depressive disorder. Electroconvulsive therapy (ECT) is a procedure which consists of the induction of convulsive crises by means of applying an electric current through the brain for therapeutic purposes. Resistance to the antidepressant medication is the main indication for ECT. The present study was planned toevaluate changes in depressive symptoms before ECT treatment, immediately after ECT treatment and at one month after ECT treatment.
Materials & Methods: A total of 30 consecutive patients diagnosed with Severe Depressive Episode as per International Classification of Diseases (ICD-10) Diagnostic Criteria for Research and satisfying the eligibility criteria were taken in the study after informed consent. ECT was administered as per prevailing guidelines by means of a medical model BPE – 2000 giving bidirectional square wave pulse at a frequency of 20-90Hz. Baseline evaluation was done one day prior to ECT treatment while Post-treatment evaluation was carried out at the end of ECT treatment and at one month after ECT treatment.
Results: The mean age of the study subjects was 38.53 years with 66.7% females and 33.3% males. Immediately post-treatment 6 participants had HAM-D scores in the range indicating no depression (score < 8), 17 had scores in the mild to moderate depressed range (scores 8-18), 6 demonstrated severe depression (19-22), and 1 had very severe depression > 22. At 1-month follow-up, 4 patients fell in the range indicating no depressive symptoms, 19 in the mild to moderate range, 5 in the severe range, and 2 in the very sever depressed range. Mean Hamilton score was 40.03, 14.32 and 14.89, before ECT, immediately after ECT and at 1 month follow up respectively (p<0.01 and p-0.19).
Conclusion: The observation made in present study strongly suggest the benefits of ECT in reducing and providing sustained relief from the acute symptoms of depression. The biggest challenge however is to deal with stigma, prejudice and resistance to the use of such an efficient treatment.
Keywords: Electroconvulsive Therapy, Hamilton Rating Scale for Depression, Severe Depression.
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