Relief of Expressed Suicidal Intent by ECT: A Consortium for Research in ECT Study

TLDR

The study is part of a multicenter trial comparing continuation ECT with pharmacotherapy to prevent relapse after successful ECT. The study aimed to assess the incidence, severity, and course of expressed suicidal intent in depressed patients undergoing ECT. Suicidal intent was measured at baseline and before each ECT session using item 3 of the 24‑item Hamilton Depression Rating Scale in 444 unipolar depression patients. Expressed suicidal intent was rapidly relieved by ECT, with 80.9 % of patients reaching zero score by the end of treatment, and the authors recommend earlier use of ECT for patients at risk.

Abstract

OBJECTIVE: This study assessed the incidence, severity, and course of expressed suicidal intent in depressed patients who were treated with ECT. The data are from the first phase of an ongoing, collaborative multicenter study, the overall aim of which was to compare continuation ECT with pharmacotherapy in the prevention of relapse after a successful course of ECT. METHOD: Suicidal intent, as expressed by patients during an interview, was scored at baseline and before each ECT session with item 3 on the 24-item Hamilton Depression Rating Scale in 444 patients with unipolar depression. RESULTS: One hundred thirty-one patients (29.5%) reported suicidal thoughts and acts (score of 3 or 4) at baseline. Scores decreased to 0 after 1 week (three ECT sessions) in 38.2% of the patients, after 2 weeks (six ECT sessions) in 61.1%, and in 80.9% at the end of the course of treatment. CONCLUSIONS: Expressed suicidal intent in depressed patients was rapidly relieved with ECT. Evidence-based treatment algorithms for major depressive mood disorders should include dichotomization according to suicide risk, as assessed by interview. For patients at risk, ECT should be considered earlier than at its conventional "last resort" position.