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Major depression, electroconvulsive therapy improves quality of life for at least six months

Electroconvulsive therapy ( ECT ) improves quality of life in patients with major depression, and that improved quality of life continues for six months.

The study is published in the Journal of Affective Disorders.

The study was conducted in seven hospitals in New York City, said W. Vaughn McCall, the lead author and at Wake Forest University School of Medicine.

" his study adds to the accumulating evidence that electroconvulsive therapy is associated with a net health benefit in depressed patients who attain and sustain remission," wrote McCall and colleagues.
Electroconvulsive therapy has long been known to be an effective treatment for major depression.

The results from 283 severely depressed patients at the seven New York City hospitals confirm results from an earlier study McCall did of 77 electroconvulsive therapy patients at Wake Forest University Baptist Medical Center, a study that was published in the November 2004 issue of the British Journal of Psychiatry.

In that study, he said, " Quality of life and function are improved in electroconvulsive therapy patients as early as two weeks after the conclusion of ECT."
In the new study, the psychiatrists said, " Electroconvulsive therapy is associated with improved health-related quality of life in the short term and the long term." Most of the improvements were largely explained by the control of depressive symptoms, McCall said.

Electroconvulsive therapy is a treatment for severe mental illness, especially major depression, in which a brief application of electric stimulus – a shock – is used to produce a generalized seizure. Doctors administer electroconvulsive therapy after the patient has been given both an anesthetic and a muscle relaxant.

Before the electroconvulsive therapy treatment, the authors said, health-related quality of life was very low.

The team measured quality of life with a tool called Medical Outcomes Study Short Form before ECT, several days after electroconvulsive therapy, and again 24 weeks later.
Before the ECT treatment, the authors said, health-related quality of life was very low: for example a measure called "vitality" was 20.4, "social functioning" was 22.8, and "emotional" was 6.4.
Six months later, vitality was 40.1, social functioning was 55.2 and emotional was 42.8.

" All these scales have a range of scores from 0 to 100 with 100 being fully functional and zero indicating a complete deficit," McCall said.

Overall, at 24 weeks, 78 percent of the patients had improved quality of life. While the study did not extend beyond six months, McCall said that in earlier studies he reported improvements in quality of life persist for a year in most patients after electroconvulsive therapy.

McCall said the evidence from the current study and his earlier ones at Wake Forest counters the argument of those who would like to severely restrict electroconvulsive therapy.

" Some agencies have recommended that electroconvulsive therapy be restricted in use because of perceived gaps in knowledge regarding it effects of health-related quality of life," McCall said.
He noted that the National Institute for Clinical Excellence in the United Kingdom recommended limits on electroconvulsive therapy , pending more information, especially on the impact of electroconvulsive therapy on quality of life.

" Our results indicate that a restrictive public policy toward electroconvulsive therapy is not warranted on the basis of the effect of electroconvulsive therapy on quality of life," McCall said.

He said there were side effects to electroconvulsive therapy.
Most patients experience temporary learning difficulties for up to two weeks after electroconvulsive therapy.
Permanent memory loss of the events in the few months preceding electroconvulsive therapy is also common, he said.

Source: Wake Forest University Baptist Medical Center, 2006