Research Article
Have access already?
Get access to this article:
Or get access to the particular issue:
- Perpetual access Add to cart ($49.95)
Or get access to the entire journal:
Advertisement
Abstract
Background
Electroconvulsive therapy (ECT) is still being administered to approximately a million people annually. There have been no ECT versus simulated ECT (SECT) studies since 1985. The five meta-analyses of ECT versus SECT studies all claim that ECT is more effective than SECT for its primary target, severe depression. This review assesses the quality of those meta-analyses and of the 11 studies on which they are based.
Methods
The meta-analyses were evaluated primarily in terms of whether they considered the quality of the studies they included, but also in terms of whether they addressed efficacy beyond end of treatment. The methodological rigor of the 11 studies included by one or more of the meta-analyses was assessed using a 24-point Quality scale developed for this review.
Results
The five meta-analyses include between 1 and 7 of the 11 studies. The meta-analyses pay little or no attention to the multiple limitations of the studies they include. The 11 studies have a mean Quality score of 12.3 out of 24. Eight scored 13 or less. Only four studies describe their processes of randomization and testing the blinding. None convincingly demonstrate that they are double-blind. Five selectively report their findings. Only four report any ratings by patients. None assess Quality of Life. The studies are small, involving an average of 37 people. Four of the 11 found ECT significantly superior to SECT at the end of treatment, five found no significant difference and two found mixed results (including one where the psychiatrists reported a difference but patients did not). Only two higher Quality studies report follow-up data, one produced a near-zero effect size (.065) in the direction of ECT, and the other a small effect size (.299) in favor of SECT.
Conclusions
The quality of most SECT–ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period. There is no evidence that ECT is effective for its target demographic—older women, or its target diagnostic group—severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or children and adolescents. Given the high risk of permanent memory loss and the small mortality risk, this longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed.
Article usage
| Period | Abstract | Full | Total | |
|---|---|---|---|---|
| Apr 2024 | 291 | 1 | 1 | 293 |
| Mar 2024 | 277 | 0 | 0 | 277 |
| Feb 2024 | 234 | 0 | 0 | 234 |
| Jan 2024 | 388 | 0 | 0 | 388 |
| Dec 2023 | 293 | 0 | 0 | 293 |
| Nov 2023 | 323 | 0 | 0 | 323 |
| Oct 2023 | 237 | 0 | 0 | 237 |
| Sep 2023 | 220 | 0 | 0 | 220 |
| Aug 2023 | 149 | 0 | 0 | 149 |
| Jul 2023 | 194 | 0 | 0 | 194 |
| Jun 2023 | 229 | 0 | 0 | 229 |
| May 2023 | 262 | 0 | 0 | 262 |
| Apr 2023 | 354 | 0 | 0 | 354 |
| Mar 2023 | 506 | 0 | 1 | 507 |
| Feb 2023 | 299 | 0 | 0 | 299 |
| Jan 2023 | 816 | 0 | 0 | 816 |
| Dec 2022 | 337 | 2 | 1 | 340 |
| Nov 2022 | 230 | 0 | 0 | 230 |
| Oct 2022 | 158 | 0 | 1 | 159 |
| Sep 2022 | 260 | 0 | 0 | 260 |
| Aug 2022 | 259 | 0 | 0 | 259 |
| Jul 2022 | 287 | 0 | 0 | 287 |
| Jun 2022 | 380 | 0 | 0 | 380 |
| May 2022 | 218 | 0 | 0 | 218 |
| Apr 2022 | 304 | 0 | 0 | 304 |
| Mar 2022 | 496 | 0 | 0 | 496 |
| Feb 2022 | 634 | 1 | 1 | 636 |
| Jan 2022 | 702 | 2 | 2 | 706 |
| Dec 2021 | 366 | 1 | 2 | 369 |
| Nov 2021 | 323 | 0 | 0 | 323 |
| Oct 2021 | 478 | 1 | 2 | 481 |
| Sep 2021 | 291 | 0 | 0 | 291 |
| Aug 2021 | 284 | 0 | 0 | 284 |
| Jul 2021 | 215 | 0 | 0 | 215 |
| Jun 2021 | 274 | 0 | 0 | 274 |
| May 2021 | 861 | 0 | 1 | 862 |
| Apr 2021 | 672 | 67 | 10 | 749 |
| Mar 2021 | 387 | 402 | 64 | 853 |
| Feb 2021 | 371 | 323 | 54 | 748 |
| Jan 2021 | 412 | 648 | 260 | 1320 |
| Dec 2020 | 414 | 331 | 77 | 822 |
| Nov 2020 | 335 | 428 | 61 | 824 |
| Oct 2020 | 351 | 467 | 48 | 866 |
| Sep 2020 | 529 | 653 | 90 | 1272 |
| Aug 2020 | 1274 | 1129 | 149 | 2552 |
| Jul 2020 | 1561 | 1787 | 252 | 3600 |
| Jun 2020 | 2421 | 4401 | 667 | 7489 |
| May 2020 | 123 | 0 | 0 | 123 |
| Apr 2020 | 86 | 0 | 0 | 86 |
Cited by