Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Jul 3;24(1):487.
doi: 10.1186/s12888-024-05933-7.

Adherence to clinical practice guidelines for using electroconvulsive therapy in elderly depressive patients

Antoine Yrondi  1   2 , Olivier Blanc  3 , Loic Anguill  4 , Christophe Arbus  4 , Ludivine Boudieu  3 , Marie-Camille Patoz  3 , Adeline Arnould  3 , Thomas Charpeaud  5 , Jean-Baptiste Genty  6 , Racan Abidine  4 , Maximilien Redon  4 , Romain Rey  7 , Bruno Aouizerate  8 , Djamila Bennabi  9 , Wissam El-Hage  10 , Bruno Etain  11 , Jérôme Holtzmann  12 , Marion Leboyer  6 , Fanny Molière  13 , Raphaelle Marie Richieri  14 , Florian Stéphan  15 , Guillaume Vaiva  16 , Anne Sauvaget  17   18 , Emmanuel Poulet  19   20   21 , Emmanuel Haffen  9 , Philippe Courtet  13 , Philippe Fossati  22   23 , Pierre-Michel Llorca  3 , Ludovic Samalin  22   3
Affiliations
Multicenter Study

Adherence to clinical practice guidelines for using electroconvulsive therapy in elderly depressive patients

Antoine Yrondi et al. BMC Psychiatry. .

Abstract

Objectives: Electroconvulsive therapy (ECT) is one of the most effective treatments in mood disorders, mainly in major depressive episode (MDE) in the context of either unipolar (MDD) or bipolar disorder (BD). However, ECT remains a neglected and underused treatment. Older people are at high risk patients for the development of adverse drug reactions. In this context, we sought to determine the duration of MDEs and the number of lines of treatment before the initiation of ECT in patients aged 65 years or over according to the presence or absence of first-line indications for using ECT from international guidelines.

Methods: In this multicenter, retrospective study including patients aged 65 years or over with MDEs in MDD or BD who have been treated with ECT for MDEs, data on the duration of MDEs and the number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests.

Results: We identified 335 patients. The mean duration of MDEs before ECT was about 9 months. It was significantly shorter in BD than in MDD- about 7 and 10 months, respectively. The co-occurrence of chronic medical disease increased the duration before ECT in the MDD group. The presence of first-line indications for using ECT from guidelines did not reduce the duration of MDEs before ECT, except where there was a previous response to ECT. The first-line indications reduced the number of lines of treatment before starting ECT.

Conclusion: Even if ECT seems to be a key treatment in the elderly population due to its efficacity and safety for MDEs, the delay before this treatment is still too long.

Keywords: Bipolar disorder; ECT; Geriatric patients; Major depressive disorder; Mood disorder.

PubMed Disclaimer

Conflict of interest statement

Pr. Samalin has received personal fees and/or non-financial support from Janssen, Lundbeck and Otsuka.

Pr Yrondi has received speaker's honoraria (AstraZeneca, Janssen, Lundbeck, Otsuka, Servier), carried out clinical studies in relation to the.

development of a medicine (Janssen) unrelated to this work.

Dr Genty has received speaker's honoraria from Servier.

Pr Sauvaget has received personal fees and/or non-financial support from Janssen, and Lundbeck.

Pr Poulet has received personal fees and/or non-financial support from Janssen, EISAI, Otsuka and Lundbeck.

Dr Holtzmann has received personal fees and/or non-financial support from Janssen and Lundbeck.

Pr Richieri has received speaker's honoraria from Otsuka and Janssen-Cilag. She has served on advisory boards for LivaNova.

Pr El-Hage has received speaker's honoraria from CHUGAI, EISAI, Lundbeck, Janssen-Cilag, and UCB unrelated to this work. He served on advisory boards for Janssen-Cilag and Lundbeck.

Pr Aouizerate has received speaker's honoraria from Lundbeck,Lilly, and Janssen-Cilag. He has served on advisory boards for Janssen-Cilag.

Pr Haffen acted in advisory capacities, carried out clinical studies inrelation to the development of a medicine, received personal researches,studies or travel allowance, gave presentations at meetings, and received remuneration for input from the following pharmaceutical organisations: AstraZeneca, BMS, Cellgene, Euthérapie—Servier, Janssen, Elli Lilly, Lundbeck, LivaNova, Otsuka, Pfizer, Sanofi.

Pr Llorca has received grants, honoraria, or consulting fees fromESAI, Gedeon Richeter, Janssen, Lundbeck, Otsuka and Sanofi.

No potential conflict of interest was reported by the other authors.

Figures

Fig. 1
Fig. 1
Comparisons according to the presence or absence of at least one first line indications for using ECT in guidelines
See this image and copyright information in PMC

References

    1. Pagnin D, de Queiroz V, Pini S, Cassano GB. Efficacy of ECT in depression: a meta-analytic review. J ECT. 2004;20:13–20. doi: 10.1097/00124509-200403000-00004. - DOI - PubMed
    1. UK Ect Review Group Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003;361:799–808. doi: 10.1016/S0140-6736(03)12705-5. - DOI - PubMed
    1. Meyer JP, Swetter SK, Kellner CH. Electroconvulsive therapy in geriatric psychiatry: a selective review. Clin Geriatr Med. 2020;36:265–279. doi: 10.1016/j.cger.2019.11.007. - DOI - PubMed
    1. Østergaard SD, Speed MS, Kellner CH, Mueller M, McClintock SM, Husain MM, et al. Electroconvulsive therapy (ECT) for moderate-severity major depression among the elderly: data from the pride study. J Affect Disord. 2020;274:1134–1141. doi: 10.1016/j.jad.2020.05.039. - DOI - PMC - PubMed
    1. van Diermen L, van den Ameele S, Kamperman AM, Sabbe BCG, Vermeulen T, Schrijvers D, et al. Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis. Br J Psychiatry J Ment Sci. 2018;212:71–80. doi: 10.1192/bjp.2017.28. - DOI - PubMed

Publication types