Electroconvulsive Therapy (ECT): A Scotland Wide Naturalistic Study of 4,826 treatment episodes

Langan-Martin, J. , Martin, D., Fleming, M., Varveris, D. and Kelly, S. (2024) Electroconvulsive Therapy (ECT): A Scotland Wide Naturalistic Study of 4,826 treatment episodes. 32nd European Congress of Psychiatry (EPA 2024), Budapest, Hungary, 6-9 April 2024.

Abstract

Introduction: Despite its apparent efficacy in the treatment of a range of psychiatric disorders including major depressive disorder (MDD), bipolar disorder, schizophrenia, post-partum psychosis and catatonia, electroconvulsive therapy (ECT) is viewed by some as a contentious treatment. Although most clinicians and researchers consider ECT a safe and effective treatment, there are ongoing and significantly publicised concerns about potential side effects. Objectives: To explore use of ECT across Scotland in a large naturalistic clinical sample across an 11-year period from 2009 to 2019. To consider the efficacy and side effects of ECT for a range of common psychiatric disorders including, depression, bipolar depression, schizophrenia, and mania. Methods: Using data from the Scottish Electroconvulsive Therapy (ECT) Accreditation Network (SEAN), information was collected for all adults who had received ECT in Scotland between 2009 and 2019. Variables included age, sex, Scottish Index of Multiple Deprivation (SIMD) quintile, International Classification of Diseases, Tenth Edition (ICD-10) diagnosis, indication for ECT, Mental Health Act status, consent status, entry and exit Montgomery-Asberg Depression Rating Scores (MADRS), entry and exit Clinical Global Index Severity CGI-S) scores and reported side effects. Side effects were recorded as present if the side effect was reported at any point during the episode of treatment. For example, headache occurring once after the second treatment of ten was recorded as present. Results: 4826 ECT episodes were recorded between 2009 and 2019. The majority of episodes were in women (68.4%, n=3,301). Average age at treatment onset was 58.52 years (95% CI 58.01 – 58.98). Males were slightly younger than females (m=58.24 years vs f= 58.65 years, p= 0.20). The mean number of treatments per episode was 9.59 (95% CI 9.32 – 9.85). Mean treatment dose delivered was 277.75mC (95% CI 272.88 – 282.63mC). Most treatments were completed as planned (68%, n=3301). 2920 episodes of treatment had both CGI-S entry and exit information available. At entry, mean CGI-S scores indicated marked illness(CGI-S 5.03 95% CI 4.99-5.07). ECT recipients diagnosed with schizophrenia had the highest CGI-S score (5.45 95% CI 5.21-5.60), followed by those with post-partum disorders (5.38, 95% CI 4.61-6.14). At exit, mean CGI scores indicated borderline illness (CGI-S 2.07, 95% CI 2.03-2.11), with ECT recipients diagnosed with a mixed affective state having the lowest CGI-S score (1.72, 95% CI 0.99-2.47) followed by those with schizoaffective disorder (2.01, 95% CI 1.76-2.42). Anaesthetic complications (n=34) and prolonged seizures (n=38) were rare (occurring in <1% of treatment episodes). Cardiovascular complications were reported in 2.2% (n= 102) of treatment episodes. Nausea was reported in 7.2% (n= 334) and muscle aches in 12% (n=560). Confusion was reported in 19% (n=879) of treatment episodes and cognitive side effects were reported in 26.2% (n=1212). One third of treatment episodes reported confusion or cognitive side effects (33.1%, n=1545).

• Item Type: Conference or Workshop Item
• Status: Published
• Refereed: No
• Glasgow Author(s) Enlighten ID: Fleming, Michael and Langan-Martin, Dr Julie
• Authors: Langan-Martin, J., Martin, D., Fleming, M., Varveris, D., and Kelly, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences
• Copyright Holders: Copyright © 2024 The Authors
• Publisher Policy: Reproduced with the permission of the authors

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