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Cited by 269Electroconvulsive Therapy StudiesTreatment of Major DepressionTranscranial Magnetic Stimulation Studies

Effectiveness of electroconvulsive therapy in community settings

Prudic, Joan, Olfson, Mark, Marcus, Steven C, Fuller, Rice B, Sackeim, Harold A·2004·Biological Psychiatry
DOI 10.1016/j.biopsych.2003.09.015
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Abstract

Background Clinical trials indicate that electroconvulsive therapy (ECT) is the most effective treatment for major depression, but its effectiveness in community settings has not been examined.Methods In a prospective, naturalistic study involving 347 patients at seven hospitals, clinical outcomes immediately after ECT and over a 24-week follow-up period were examined in relation to patient characteristics and treatment variables.Results The sites differed markedly in patient features and ECT administration but did not differ in clinical outcomes. In contrast to the 70%-90% remission rates expected with ECT, remission rates, depending on criteria, were 30.3%-46.7%. Longer episode duration, comorbid personality disorder, and schizoaffective disorder were associated with poorer outcome. Among remitters, the relapse rate during follow-up was 64.3%. Relapse was more frequent in patients with psychotic depression or comorbid Axis I or Axis II disorders. Only 23.4% of ECT nonremitters had sustained remission during follow-up.Conclusions The remission rate with ECT in community settings is substantially less than that in clinical trials. Providers frequently end the ECT course with the view that patients have benefited fully, yet formal assessment shows significant residual symptoms. Patients who do not remit with ECT have a poor prognosis; this underscores the need to achieve maximal improvement with this modality.

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  • Necessity of ECT is mentioned 13 times as an administrative criterion.

    “and necessity of ECT 13 times (1, 8, 16, 17, 19, 21, 26, 27, 38, 40, 46, 48, 50, 52).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [38]

  • Suicide/suicide attempt is mentioned 19 times as an administrative criterion.

    “Suicide/suicide attempt is mentioned 19 times (1, 15, 16, 18, 19, 26, 27, 33, 37, 38, 41, 43–46, 48–50, 52)”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [38]

  • The extracted medians showed substantial heterogeneity, ranging from very early relapse in severe or treatment-resistant samples with medians between 53 and 90 days to substantially longer intervals in maintenance-treated populations (218-294 days).

    “The extracted medians showed substantial heterogeneity, ranging from very early relapse in severe or treatment−resistant samples with medians between 53 and 90 days (14, 21, 23, 38) to substantially longer intervals in maintenance−treated populations (218–294 days) (33, 40, 45).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [38]

  • Prudic et al. and Atiku et al. consider hospitalization, ECT, treatment reintroduction, or suicide attempts sufficient to define relapse.

    “Prudic et al. (38) and Atiku et al. (24) likewise consider hospitalization, ECT, treatment reintroduction, or suicide attempts sufficient to define relapse.”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [38]

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Authors
Prudic, J., Olfson, M., Marcus, S. C., Fuller, R. B., & Sackeim, H. A.
Affiliations
  • New York State Psychiatric Institute (US)
  • University of Pennsylvania (US)
Corresponding author
Prudic, Joan
ORCID
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2004-02
Volume
55
Issue
3
Pages
301-312
ISSN
0006-3223 (ISSN-L)
DOI
10.1016/j.biopsych.2003.09.015
OpenAlex
W1973005276
Cited by
269
References
68
Citations by year
2026: 6 · 2025: 3 · 2024: 9 · 2023: 16 · 2022: 8 · 2021: 10 · 2020: 11 · 2019: 28 · 2018: 5 · 2017: 12 · 2016: 19 · 2015: 10 · 2014: 11 · 2013: 12 · 2012: 11
FWCI
9.54
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R01 MH 61609, R01 MH35636, R01 MH59069, R01MH035636, R01MH061609, R01MH059069)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords
electroconvulsive therapy, major depressive disorder, community settings, remission rate, relapse, residual symptoms, psychotic depression, personality disorder comorbidity, schizoaffective disorder, treatment outcomes, naturalistic study
MeSH terms
Adult, Aged, Aged, 80 and over, Analysis of Variance, Mental Disorders, Major Depressive Disorder, Electroconvulsive Therapy, Female, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome

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