[Electroconvulsive therapy at the Department of Psychiatry and Psychotherapy, University of Munich. Development during the years 1995-2002]

Abstract

Background: So far, electroconvulsive therapy (ECT) has been proven to be a reliable and the most effective somatic treatment of depression or schizophrenia. This holds especially true for disturbances, which are refractory to pharmacological treatments.

Patients and methods: We evaluated 4803 treatments in 445 patients. Main outcome criteria were efficacy and tolerability of treatment. Moreover, prospectively recorded neurophysiological parameters that might influence treatment outcome and treatment modalities and were assessed in a retrospective study design.

Results: During the last 7 years developmental changes show an increasing call for ECT treatment. Despite not being able to satisfy all demands the number of treatments more than doubled during the time period investigated. According to the latest scientific knowledge, especially in unipolar ECT, higher stimulation energy has been used to provide better treatment efficacy. Nevertheless, this was accompanied by a lower incidence of cognitive side effects. Due to the better tolerability of the treatment and the prospective neurophysiological indices, it appears that treatment quality has improved in recent years. Overall treatment efficacy was not improved, but could be maintained on a stable high level. This is presumably due to a stronger negative selection of patients with more pharmacotherapy-refractory disturbances.

Conclusion: ECT still represents an important option in the treatment of therapy-resistant depression and schizophrenia despite recent progress in neuropsychopharmacology.