Literature Review On Effectiveness Of Electroconvulsive Therapy In Treating Depression

Introduction Unlike instances of occasional sadness of blue moods, depression is a mood disorder. Depression causes persistent feelings of loss of interest, aversion and sadness. Contrary to popular belief, it is a fact that depression is not a manifestation of weakness. It is a medical condition which has real and defined symptoms. Depression can be treated, and the affected can make a full recovery. During treatment, medications, psychotherapies and counseling among other methods can be used individually or in combination. One of the methods used in the treatment of depression is electroconvulsive therapy. This is a treatment option where an electric current from a source is passed through an individual’s brain with the deliberate intention of triggering a momentary seizure. The rationale for the use of electroconvulsive therapy is the change in brain chemistry, the effect of which is a quick reversal of symptoms of some mental illnesses. In the treatment of depression, electroconvulsive therapy is usually a last result when all other methods have proven ineffective. This paper argues that electroconvulsive therapy is the most effective treatment option for depression to-date.Review of literature As highlighted above, there are various treatment options for depression. Antidepressants have been used extensively to treat depression. The shortcoming of antidepressants is that either the patients do not show adequate response or cannot tolerate the resultant side-effects. Electroconvulsive therapy is more effective that the other treatment options for depression for a number of reasons. Antunes et al., (2009) argue that the effectiveness of electroconvulsive therapy is shown by the fact that the treatment option is indicated when there is resistance to the prescribed antidepressant medication. Additionally, electroconvulsive therapy is effective as a treatment option for depression because it elicits a faster response to treatment compared to the use of counseling and antidepressants when used individually or in combination. This fast response to treatment is very important, especially in situations that give an indication for emergency interventions. These are situations where the patients have also been diagnosed with a suicide risk or catatonia. The effectiveness of electroconvulsive therapy in treating these conditions is also recognized by the American Psychological Association. This is evidenced by their directive for the use of electroconvulsive treatment as the first choices when these situations are diagnosed in a patient (Antunes et al., 2009). The effectiveness of electroconvulsive therapy has also been demonstrated empirically. In a study by Khalid et al., (2008), the results belonging to thirty-eight patients with depression and received more than six sessions of electroconvulsive therapy or had achieved remission prior to this study were analyzed. On average, these patients had spent 14.6 months in the episodes they in which they were at the time. Additionally, the patients were in a state of clinical depression for 6.2 years. On average, the patients showed resistance and a failure to respond to 5.4 different pharmacological treatments. When these patients were taken through the sessions of electroconvulsive treatment, 65.8% of the patients responded to the treatment as shown by HDRS24 of >or=50% (Khalid et al., 2008). Additionally, 53.3% of the patients achieved remission when take through the electroconvulsive therapy as shown by a HDRS24 score that was less than or equal to 10 and an improvement in the HDRS24 score of greater or equal to 60%. The study did not find any association between the improvements after treatment with electroconvulsive and the number of previously unsuccessful trials with pharmacological antidepressants (r = -0.04, P = 0.8). The empirical evidence in this study collaborates the effectiveness of electroconvulsive therapy in the treatment of depression in two ways (Khalid et al., 2008). Firstly, even patients who had been previously treated with pharmacological antidepressants and did not respond can still be successfully treated with electroconvulsive therapy. Secondly, more than 50% of the patients with clinical depression who resisted other forms of treatment achieved remission when they were treated using electroconvulsive therapy (Khalid et al., 2008). Electroconvulsive therapy was also shown to be effective in treating atypical depression. In a study where the use of electroconvulsive therapy in the treatment of atypical depression was compared to the use of electroconvulsive therapy in the treatment of typical depression, the remission rate was 80.6% and 67.1% respectively (Husain et al., 2008). Besides the remission of symptoms when depression is treated using electroconvulsive therapy, the treatment option has also been proved to improve the quality of life for patients. In an evaluation of 283 patients with depression using the SF-36 scale, as a measurement tool for the quality of life, McCall et al., (2006) showed that 87% exhibited an immediate improvement in the scores of the tool used to measure the quality of life after treatment with electroconvulsive therapy while 78% of sample still sustained this improvement six months after they were given the electroconvulsive therapy. The National Institute for Clinical Excellence prepares guidelines for use in the treatment of patients in order to improve patient outcomes. In preparing the guidelines for the treatment of depression, the organization reviewed ninety randomized clinical trials regarding the effectiveness of using electroconvulsive therapy in the treatment of depression. The review concluded that the use of electroconvulsive therapy is more beneficial in the treatment of depression compared to the use of antidepressants. Additionally, the review concluded that real electroconvulsive therapy is more effective compared to the use of simulated electroconvulsive therapy (National Institute for Clinical Excellence, 2003). The studies discussed above give empirical evidence regarding the effectiveness of electroconvulsive therapy in the treatment of clinical depression. The major elements in the empirical evidence adduced by the studies is the ability of the treatment option to elicit response, even in patients who have shown prior resistance to treatments options such as the use of pharmacological antidepressants. Additionally, the empirical evidence indicates the rate of remission for patients who have been treated using electroconvulsive therapy. As highlighted earlier, there are guidelines that are followed in the treatment of depression. In preparing these guidelines, the National Institute for Clinical Excellence highlighted the efficiency of electroconvulsive therapy as a treatment option for clinical depression in National Institute for Clinical Excellence. This was based on their analysis that concluded that electroconvulsive treatment is an efficient treatment option. Many years later, the conclusions by National Institute for Clinical Excellence are yet to be challenged.Conclusion It is not arguable that depression is a real medical condition with real symptoms. The upside is that the medical condition can be treated using individual or a combination of approaches. Electroconvulsive therapy is one such treatment approach that has been used in treating depression. Its effectiveness is unrivaled by the other treatment options available. The paper has adduced both theoretical and empirical evidence to back the claims of its effectiveness. Meta-analysis of numerous studies has shown its likelihood of eliciting a positive response is high than the other treatment options. Studies have also proved that it has a higher rate of symptom remission.

References

Antunes, P., Rosa, M., Belmonte-de -Abreu, P. Lobato, M and Fleck, M. (2009). Electroconvulsive therapy in major depression: current aspects. Brazilian Journal of Psychiatry, 31, 1. http://dx.doi.org/10.1590/S1516-44462009000500005 
Husain, M., McClintock, M., Rush, J., Knapp, G., Fink, M., Rummans, A., Rasmussen, K., Claassen, C., Petrides, G., Biggs, M., Mueller, M., Sampson, S., Bailine, H., Lisanby, H., Kellner, H. (2008). The efficacy of acute electroconvulsive therapy in atypical depression. Journal of Clinicak Psychiatry.; 69(3):406-11.
Khalid, N., Atkins, M., Tredget, J., Giles, M., Shampney-Smith, K. and Kirov, G. (2008). The effectiveness of electroconvulsive therapy in treatment-resistant depression: a naturalistic study. Journal of Electroconvulsive treatment, 24(2): 141-145
McCall, V., Prudic, J., Olfson, M., Sackeim, H. (2006). Health-related quality of life following ECT in a large community sample. Journal of Affective Disorders. 90(2-3):269-74.
National Institute for Clinical Excellence. (2003). Guidance on the use of electroconvulsive therapy. London: NICE; Retrieved from: http://www.nice.org.uk/pdf/ 59ectfullguidance.pdf