Electroconvulsive therapy ineffective in reducing suicide risk among patients with depression

UK: A course of electroconvulsive therapy (ECT) is not associated with a decreased risk of death by suicide in the patient suffering from depression when compared with other mental health care, states an article published in the Journal of Clinical Psychiatry.

Global survey reports, that more than 90% of suicides are linked to a mental disorder, most commonly major depressive disorder. In patients with depression, the risk of suicide remains elevated for many years after discharge from psychiatric inpatient care. Electroconvulsive therapy, a psychiatric treatment where a generalized seizure is electrically induced to manage refractory mental disorders, is an effective treatment for depression.

Current guidelines indicate ECT for patients with severe major depression, including those with psychosis, catatonia, and/or an elevated suicide risk. The use of ECT is still debated, in part because there is a lack of data regarding its effect on suicide risk. It is currently unclear if a course of electroconvulsive therapy (ECT) is associated with a decreased risk of death by suicide. The limited literature based on evidence either does not reflect contemporary practice or else includes patients receiving as few as one treatment.

Bradley V, Geisel Medical School at Dartmouth College, New Hampshire, UK, and his team conducted a study to examine the association of adequate exposure to ECT treatment with the risk of death by suicide in a present-day sample.

Researchers conducted a study using electronic medical record data from the Department of Veterans Affairs health system and included 5,157 patients who received index courses of ECT and 10,097 matched controls who did not receive ECT for the study. They compared all-cause and suicide mortality among patients who received an index course of ECT with a comparison group created through propensity score matching. Mortality was measured and analyzed for ECT and controls at both 30 days and 1 year.

Key findings of the study,

• The suicide death rate in those receiving ECT was 137.34 deaths per 10,000 in 30 days and 804.39 per 10,000 in 1 year.

• The rate of death by suicide in the control group was 138.65 per 10,000 in 30 days and 564.52 per 10,000 in 1 year.

• The relative risk of death by suicide comparing those receiving an index course of ECT and the matched group was 0.96 in 30 days and 1.38 in 1 year.

The authors conclude that the risk of suicide mortality 30 days and 1 year following treatment was similar in patients treated with an index course ECT and in a matched group. The study data showed no evidence that an ECT course decreased the risk of death by suicide.

Reference:

Watts BV, Peltzman T, Shiner B. Electroconvulsive Therapy and Death by Suicide. J Clin Psychiatry. 2022 Apr 13;83(3):21m13886. doi: 10.4088/JCP.21m13886. PMID: 35421285.