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