Does ECT Work? the Impact of ECT on Depression

AIMS: The aim of this project was to evaluate the impact of ECT on depression and mood symptoms. METHODS: 50 patients who were treated with ECT within NSFT (2020–22) were assessed using extended Hamilton Depression Rating Scale (HDRS, observer rated depression scale). This rates depression out of a possible 40, with higher scores indicated more severe depression: under 7 indicating no depression, 8–16 mild depression, 17–23 moderate depression and over 24 as severe depression. Cognition was also assessed (using Mini Ace) . HDRS was carried out at the start, mid point (session 6–8) and end of ECT, and scores were then evaluated. RESULTS: All patients showed a significant drop in HDRS scores and an improvement in depressive symptoms (even the ones who were no being primarily treated for depression). This effect was most notable between start and mid point of ECT. Mean scores at start of ECT were 24/40 (range 11–36), mean at mid point was 11 (range 4–25) and mean at end of treatment was 7 (range 0–14). CONCLUSION: This Project would seem to reflect the findings from functional neuroimaging: that the greatest impact of ECT on neurophysiology and anatomy (including on brain structures) occurs in about the first 6- 8 sessions. This positive effect continues with subsequent treatment but at a reduced gradient. The effect is noted to be statistically significant for this project/sample. In Conclusion: all 50 patients started ECT depressed (again, even those who were not being primarily treated for depression) and all patients improved with ECT. At the end of ECT, only 7 patients scored over 7 on HDRS and none over 14 (i.e. only 7 (14%) of patients were assessed as having mild depression compared with 50 (100%) at the start of ECT treatment). This project would further support that ECT is a highly effective treatment for depression, especially when a rapid response is required due to severity or threat to life (such as catatonic or not eating/drinking, as was the case 6 patients seen) or for psychotic depression (12 patients). It is notable that all patients had a reduction in depressive symptoms, even those not presenting with depression or marked mood symptoms.