Written by Joao L. de Quevedo, MD, PhD
Electroconvulsive therapy (ECT) has long been a critical treatment for severe psychiatric conditions such as schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder. A recent study published in JAMA Psychiatry highlights the importance of continuing ECT treatment beyond the acute phase, showing that patients receiving continuation or maintenance ECT are less likely to be readmitted to the hospital than those who undergo only acute treatment.
What is Acute, Continuation, and Maintenance ECT?
The study, led by Dr. Anders Jørgensen of the Psychiatric Center Copenhagen, analyzed data from 19,994 patients in the Danish Patient Registry between 2003 and 2022. ECT treatments were categorized into three types:
– Acute ECT: A series of at least three treatments administered within seven days between adjacent sessions.
– Continuation ECT: Administered after an acute ECT series, with treatments spaced 7-90 days apart within a 180-day time frame.
– Maintenance ECT: Treatments administered beyond 180 days after the acute ECT series, with 7-90 days intervals.
Despite the clear benefits of continuing ECT treatment, the study found that fewer than 8% of patients received continuation or maintenance ECT after their initial acute phase.
Lower Risk of Hospitalization
The study’s results revealed that patients who received continuation or maintenance ECT had a significantly lower risk of hospitalization. Compared to patients who received acute treatment alone, those who continued treatment had a 32% lower risk of hospital readmission within six months and a 38% lower risk in the second six months after completing their acute ECT series.
Interestingly, patients with schizophrenia or schizoaffective disorder were more likely to receive continuation or maintenance ECT than those with other psychiatric disorders. However, the study also noted that continuation or maintenance of ECT did not appear to reduce the risk of suicidal ideation, highlighting that this treatment primarily helps in stabilizing overall mental health rather than addressing acute suicidal thoughts.
Clinical and Cost Benefits
The findings point to the underutilization of ECT continuation and maintenance despite its effectiveness in reducing hospital readmissions. The researchers emphasized that this form of treatment is clinically advantageous and cost-effective. By reducing the need for hospitalizations, continuation, and maintenance, ECT helps mitigate the long-term financial burden associated with acute psychiatric episodes.
The study underscores the need for increased awareness among healthcare providers and patients about the benefits of continuing and maintaining ECT, suggesting that more widespread implementation could improve patient outcomes and reduce healthcare costs.
Reference: Anders Jørgensen, Frederikke Hoerdam Gronemann, Maarten P Rozing, Martin B Jørgensen , Merete Osler. Clinical Outcomes of Continuation and Maintenance Electroconvulsive Therapy. JAMA Psychiatry 2024 Sep 18:e242360. doi: 10.1001/jamapsychiatry.2024.2360. Online ahead of print.
Information:
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