The need to expand access to electroconvulsive therapy: a retrospective analysis of a new academic service.

Background: Studies have long described the efficacy of electroconvulsive therapy (ECT); however, access to care continues to be an obstacle to treatment. Despite national trends resulting in declining availability of ECT, a new academic service was created to serve the needs of an area with limited resources. In this study, the characteristics and outcomes of patients receiving treatment during the first year of a new ECT program were assessed. The goals were to analyze treatment outcomes in this population and to identify associations between patient characteristics, treatment parameters, and clinical response.

Methods: Medical charts from the first 49 patients undergoing ECT between October 2010 and September 2011 were retrospectively reviewed. Patient characteristics, indications for ECT, and treatment parameters were compared with clinical improvement as defined by the Montgomery-Asberg Depression Rating Scale (MADRS).

Results: Of the 46 patients included in this study, the majority were female (63%), Caucasian (89%), and diagnosed with major depressive disorder (63%). The acute series duration ranged from 3 to 29 treatments (median of 13), with 50% (n=23) of patients achieving remission (MADRS<10) and 78% (n=36) achieving response (MADRS reduction > 50%) at the completion of the acute series. Positive outcomes were found to be associated with a history of medication-resistant conditions.

Conclusions: ECT is a highly effective intervention for the treatment of depression and continues to be a sought-after therapy. Efficacy rates in the first year of this service were comparable to what has been reported in the general population and emphasize the need for the continued availability of ECT as a treatment option.