Effectiveness and Safety of Electroconvulsive Therapy in Clinical Practice

Sung Woo Joo; Ha Eun Jeong; Myong-Wuk Chon; Yeon Ho Joo; Chang Yoon Kim; Jung Sun Lee

doi:10.4306/jknpa.2016.55.3.202

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Joo, Jeong, Chon, Joo, Kim, and Lee: Effectiveness and Safety of Electroconvulsive Therapy in Clinical Practice

Original Article

Journal of Korean Neuropsychiatric Association 2016; 55(3): 202-208.

Published online: 31 August 2016

DOI: https://doi.org/10.4306/jknpa.2016.55.3.202

Effectiveness and Safety of Electroconvulsive Therapy in Clinical Practice

Sung Woo Joo, MD, Ha Eun Jeong, MD, Myong-Wuk Chon, MD, Yeon Ho Joo, MD, PhD, Chang Yoon Kim, MD, PhD, Jung Sun Lee, MD, PhD

Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Address for correspondence: Jung Sun Lee, MD, PhD. Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel +82-2-3010-3422, Fax +82-2-3010-3410, js_lee@amc.seoul.kr

Received 17 May 2016 Revised 14 July 2016 Accepted 19 July 2016

Abstract

Objectives

There is little research on the practice and effectiveness of electroconvulsive therapy (ECT) in Korea. This study investigated the practice pattern, effectiveness, and safety of ECT.

Methods

This chart review study included electronic medical records of 180 patients treated with ECT between January 2007 and December 2013 at the Asan Medical Center. Symptomatic improvement was assessed using Clinical Global Impression (CGI) scale. Treatment response was defined as CGI improvement scale score of 2 or less. Re-hospitalization was used as an indicator of recurrence. Safety was assessed by spontaneous reports from patients.

Results

One hundred and eighty patients underwent 1539 sessions of modified ECT. Their most frequent diagnosis was major depressive disorder (n=74, 41.1%). The most common indication for ECT was poor response to medication (n=177, 75.3%). Treatment response rate was 66.9% in acute phase group and 63.8% in the patients with poor response to medication. The recurrence rate at six months after the end of the course was 29.6%. Memory impairment or amnesia was the most common adverse effect.

Conclusion

There was a remarkable improvement following ECT in patients who responded poorly to medications, and most adverse effects were tolerable and temporary. The present study suggests that ECT could be a useful treatment option.

Keywords: Electroconvulsive therapy, Effectiveness, Survey, Safety

Figures and Tables

Fig. 1

Kaplan-Meier curves showing proportion of acute phase group who had a response to ECT, without continuation or maintenance ECT (n=145) : (A) whole group, (B) according to diagnosis. NOS : Not otherwise specified, ECT : Electroconvulsive therapy

Table 1

Demographic and clinical characteristics of patients

^* : Excluded 34 patients' medical records in which information on prescription could not be obtained. SD : Standard deviation

Table 2

Clinical characteristics of acute phase group (n=239)

^* : Excluded four acute phase courses of which medical records did not include data about treatment indication and reason to discontinue ECT. SD : Standard deviation, ECT : Electroconvulsive therapy

Table 3

The number of session with the initial treatment response and treatment response rate of acute phase group (n=236)

^* : Comparisons among diagnoses were conducted by Kruskal-Wallis test and post-hoc analyses by Mann-Whitney test in the courses with treatment response : schizophrenia >major depressive disorder (p=0.001), bipolar depression (p=0.002), ^† : Treatment response was defined as Clinical Global Impression global improvement scale score of 2 or less. Comparisons among diagnoses were assessed by Pearson chi-square test (χ²=16.830, p=0.005) and post-hoc analyses by Pearson chi-square test : Bipolar depression (p=0.001), Bipolar manic (p=0.003) >Psychotic disorder, NOS. SD : Standard deviation, NOS : Not otherwise specified

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

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