ECT is the most acutely efficacious treatment for severe major depression.It is recognised that use of ECT is highly variable across countries/between hospitals/psychiatrists.
Brady G. Case and colleagues analyzed data for the years 1993–2009 from the US Nation wide Inpatient Sample (NIS), a nationally representative survey (20%) of community hospitals (general hospitals) .Freestanding psychiatric facilities, long-term hospitals and short-term rehabilitation hospitals were not included in the study. Results show that the annual number of stays involving ECT fell from 12.6 to 7.2/100,000 adult US residents. The decline was more among elderly persons. The percentage of hospitals conducting ECT decreased from 14.8% to 10.6%.
The data suggest that the probability that the treating hospital of a severely depressed inpatient conducts ECT fell by one-third during this period. It is interesting to note that receipt of ECT was unchanged for patients treated within hospitals which conduct the procedure.
Why are fewer general hospitals conducting ECT? Is it due to increase in OP use of ECT? Authors do not think this is the case as cessation of inpatient ECT in a hospital is more likely to eliminate conduct of the procedure for outpatients as well .Investigators did not find any increase in transfers from hospitals that do not conduct ECT to others who conduct ECT. Study could not look in to the impact of changing pharmacological practices that could have reduced the need for ECT.Increase in use of antidepressants is not associated with decrease in ECT, at least in some countries (eg Canada).
In an accompanying commentary, Richard D. Weiner and Joan Prudic, explores the issue further. Outpatient ECT is gradually becoming the norm in some centres. In Duke University Hospital, the proportion of outpatient ECT (index and maintenance together) increased from 32.3% in 1993 to 75.6% in 2009 and further increased to 83.5% in 2011. In 2011, 67.5% of index treatments ( first treatment) were outpatient. The study has shown that the decrease in ECT is primarily due to decrease in the general hospitals performing ECT. This should be seen along with the fact that ECT is increasingly being centralized to a smaller group of facilities, which as a whole are likely offering this treatment modality to larger numbers of patients. National data ( comprising all facilities) on ECT is not available to conclude that overall ECT use is decreasing. Data from Texas state suggest an increase of 12% overall utilisation rate. Weiner and Prudic believe that ECT has become safer and effective and they expect a resurgence of interest and use.
Summary of the article:
Case BG, Bertollo DN, Laska EM, Price LH, Siegel CE, Olfson M, Marcus SC. Biol Psychiatry. 2013 Jan 15;73(2):119-26.