Depression 7% - 12% for men 20% - 25% for women 4th highest contributor to total burden of disease 2nd leading cause of disability by 2020 Low mood or Anhedonia Weight Sleep Concentration Psychomotor agitation/ retardation Fatigue Worthlessness/ guilt Suicidal thoughts The symptoms cause clinically significant impairment in functioning
SF-36 A generic outcome measure Subjectively rated Only 36 questions 8-scale profile of functional health and well-being Psychometrically-based physical and mental health summary measures Normative data Sensitive to change Most frequently used patient rated outcome measure used in clinical trials (Scoggins & Patrick 2009)
Summary Depression significantly impacts HRQOL ECT is associated with improvements in subjectively assessed HRQOL High dose RUL ECT is as effective as standard bitemporal ECT Persistent deficits 6 months after treatment Remission status at EOT explained persistent deficits
Strengths & limitations Strengths – Randomized design – Large sample size – New information about HDRUL ECT – Generalizable results – No difference between participants that completed assessments and those that did not – Robust outcomes measure – Robust data analysis approach Limitations – Loss of data at 6 months
Health related quality of life HRQOL – depression HRQOL – depression and ECT HRQOL – depression and ECT and NICE ‘03 + ‘09
Electroconvulsive therapy The UK ECT Review Group (2003) - meta-analysis: – Real ECT more effective than simulated ECT: – 9·7 point difference in HDRS Janicak et al (1985) – Meta-analysis: – MAOI – ECT more effective by 45% – Tricyclic – ECT more effective by 20% SSRI – ECT significantly more effective than Paroxetine (Folkerts et al. 1997): – 59% Vs reduction 29% reduction in HDRS score.