Intervention Review

Electroconvulsive therapy for the depressed elderly

  1. ML Stek1,*,
  2. Frits FB Wurff van der2,
  3. WJG Hoogendijk3,
  4. ATF Beekman3

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 20 JAN 2007

DOI: 10.1002/14651858.CD003593

Database Title

Additional Information

How to Cite

Stek ML, Wurff van der FFB, Hoogendijk WJG, Beekman ATF. Electroconvulsive therapy for the depressed elderly. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003593. DOI: 10.1002/14651858.CD003593.

Author Information

  1. 1

    Academische afdeling psychiatrie, circuit ouderen GGZ Buitenamstel, academische afdeling psychiatrie, Amsterdam, Netherlands

  2. 2

    Vrije Universiteit, Amsterdam, The Netherlands, Department of Psychiatry, Amsterdam, Netherlands

  3. 3

    Amsterdam, Netherlands

*ML Stek, circuit ouderen GGZ Buitenamstel, academische afdeling psychiatrie, Academische afdeling psychiatrie, Valeriusplein 9, Amsterdam, 1075 BG, Netherlands. m.l.stek@ggzba.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (58K)Standard (374K)Full (387K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Depressive disorders are common in old age, with serious health consequences such as increased morbidity, disability, and mortality. The frailty of elderly people may seriously hamper the efficacy and safety of pharmacotherapy. Therefore, electroconvulsive therapy (ECT) may be an alternative to treatment with antidepressants.

Objectives

To assess the efficacy and safety of ECT compared to simulated ECT or antidepressants in depressed elderly people.

Search methods

We searched the CCDAN Controlled Trials Register on 21/1/2007, MEDLINE 1966-2006, EMBASE 1980-2006, Biological abstracts 1985-2006, CINAHL 1982-2006, Lilacs from 1982 onwards, Psyclit 1887-2006, Sigle 1980-2006. Reference lists of relevant papers were scanned. The Journal of ECT, the International Journal of Geriatric Psychiatry and the American Journal of Geriatric Psychiatry were handsearched.

Selection criteria

Randomised controlled trials of ECT for elderly people (>60 years) with depression, with or without concomitant conditions such as cerebrovascular disease, dementia (including Alzheimer's type and vascular) and Parkinson's disease were included.

Data collection and analysis

Data were independently extracted by at least two review authors. Weighted mean differences (WMD) between groups were calculated for continuous data.

Main results

Randomised evidence was sparse. Only four trials were eligible for inclusion, one comparing the efficacy of real ECT versus simulated ECT, two comparing the efficacy of unilateral versus bilateral ECT and the other comparing the efficacy of ECT once a week with ECT three times weekly. All trials had major methodological shortcomings; reports were mostly lacking essential information to perform a quantitative analysis. Although the findings from one study (35 participants) concluded that real ECT was superior to simulated ECT, these conclusions need to be interpreted cautiously. Only results from one of the trials (29 participants) comparing unilateral versus bilateral ECT could be analysed, and did not show convincing efficacy of unilateral ECT over bilateral ECT, WMD 6.06 (CI -5.20 to 17.32). Randomised evidence on the efficacy and safety of ECT in depressed elderly with concomitant dementia, cerebrovascular disorders or Parkinson's disease was lacking completely. Possible side-effects could not be adequately examined because of the lack of randomised evidence and methodological shortcomings.

Authors' conclusions

None of the objectives of this review could be adequately tested because of the lack of firm, randomised evidence. Given the specific problems in the treatment of depressed elderly, a well designed randomised controlled trial should be conducted in which the efficacy of ECT is compared to one or more antidepressants.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Electroconvulsive therapy (ECT) for depression in elderly people

Antidepressant drugs often cause side effects in elderly people, which may limit the effectiveness of treatment for depression. ECT can be an important alternative to drug treatment for depressed elderly people. This review involved searching the literature for well-conducted (randomised) studies that compared ECT to both simulated ECT and to antidepressants. The review found only four studies, all of which had serious problems in their methods. At present, therefore, it is not possible to draw firm conclusions on whether ECT is more effective than antidepressants,.or on the safety or side effects of ECT in elderly people with depression.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

電痙攣治療對憂鬱老年人的治療

憂鬱症常見於老年人,影響深遠包含增加發病率,殘障率和死亡率. 長者較脆弱,可能影響藥物治療的藥效和安全性. 因此電痙攣治療法可以是替代療法

目標

評估電痙攣治療與模擬電痙攣治療或抗憂鬱藥物對憂鬱長者的療效和安全性

搜尋策略

搜尋the CCDAN Controlled Trials Register on 21/1/2007, MEDLINE 1966 – 2006, EMBASE 1980 – 2006, Biological abstracts 1985 – 2006, CINAHL 1982 – 2006, Lilacs from 1982 onwards, Psyclit 1887 – 2006, Sigle 1980 – 2006. 檢閱相關文章的文獻. 手動搜尋The Journal of ECT, the International Journal of Geriatric Psychiatry and the American Journal of Geriatric Psychiatry.

選擇標準

對60歲以上憂鬱症老年人使用電痙攣治療的隨機對照試驗. 老年人可能有或沒有其他病症如腦血管疾病,癡呆(包含阿茲海默性和血管性)和帕金森氏症

資料收集與分析

至少兩個檢閱者獨立擷取資料. 計算連續資料組間加權平均差

主要結論

隨機對照試驗很少. 只有4個試驗可納入. 其中1個比較電痙攣治療和模擬電痙攣治療的療效;2個試驗比較單邊和雙邊電痙攣治療;另1個比較每週一次和三次電痙攣治療的療效. 所有試驗都有嚴重方法學缺點,報告也多缺少量化分析需要的重要資料. 雖1個試驗發現(35受試者)電痙攣治療比模擬電痙攣治療好,但此結論解讀時須小心. 只有1個比較單邊和雙邊電痙攣治療試驗(29受試者)的結果可分析,沒有顯著證明指出單邊優於雙邊電痙攣治療,加權平均差為6.06 (CI −5.20 to 17.32). 對憂鬱且併有癡呆,腦血管疾病和帕金森氏症的老年患者,完全沒有關於使用電痙攣治療療效和安全的隨機證據

作者結論

本回顧的目的都無法充分達成,因為缺少強力隨機證據. 老年憂鬱症病人治療有特殊問題,更需要設計良好的隨機對照試驗比較電痙攣治療和1或多個抗憂鬱藥

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

電痙攣治療對憂鬱老年人的治療: 抗憂鬱藥常在老人引起副作用,這些副作用會限制憂鬱藥物的療效. 電痙攣治療對老年憂鬱症患者可能是重要的替代療法. 本回顧搜尋完善執行(隨機)的文獻,比較電痙攣治療,模擬電痙攣治療和抗憂鬱藥. 只有4個試驗可納入, 所有試驗都有嚴重方法學缺點. 因此目前無法得到有力結論確定是否治療憂鬱老年人時,電痙攣比抗憂鬱藥物療效好且安全性高或副作用少.

View Full Article (HTML) Summary (58K)Standard (374K)Full (387K)