Electroconvulsive therapy in the elderly and nonelderly: 10 years' retrospective comparison

Abstract

Background: Although electroconvulsive therapy (ECT) is a well-established treatment modality worldwide for elderly with severe psychiatric disorders, literature is sparse in India. Materials and Methods: A retrospective chart review of patients aged 60 years and above (n = 90) who received a course of ECTs between April 2003 and 2013 in National Institute of Mental Health and Neurosciences, Bengaluru, a tertiary care neuropsychiatric institute, was carried out. For each elderly person, the next consecutive nonelderly ECT patient was selected as a control (n = 85). Clinical, demographic, and ECT variables were compared. Results: Depression (n = 57; 63.3%) was the most common diagnosis for ECT among the elderly while schizophrenia (n = 28; 32.9%) was most common among controls (P < 0.01); suicidal ideas were the most common indication (n = 25; 28.4%) among the elderly while aggression was the most common indication among controls (n = 28; 33.3%) (P = 0.004). Elderly received more number of ECTs (mean [standard deviation (SD)] 8.0 [3.0] vs. 6.4 [2.8]; P ≤ 0.01), had higher seizure threshold (mean [SD] 135.3 [76.9] mc vs. 81.3 [54.2] mc; P < 0.01), and experienced lesser duration of motor seizures (mean [SD] 38.48 [9.72] s vs. 48.90 [14.66]; P < 0.01). Immediate post-ECT cognitive deficits were more in the elderly (n = 19; 21.6% vs. n = 7; 8.3%; P = 0.02). Case records showed no between-group differences both at the end of 3-month (P = 0.40) and 6-month (P = 0.50) follow-up for cognitive complaints. Mean (standard deviation) Clinical Global Impression-Improvement scores at the end of ECT course were 2.3 (0.9) versus 2.4 (0.8) (P = 0.5) among elderly and nonelderly, respectively. These scores were comparable at the end of 3 as well as 6 months' follow-up. Conclusions: This retrospective chart review showed ECT to be safe and effective for geriatric patients with severe psychiatric disorders including cognitive adverse effects. However, prospective studies would help to better establish cognitive adverse effects of ECT.