[Electroconvulsive therapy in the treatment of depression in elderly]

Ewa Hordyńska, Danuta Palińska, Tomasz Sobów
Psychiatria Polska 2003, 37 (3): 445-55

INTRODUCTION: The use of a electroconvulsive therapy (ECT) in the elderly suffering from depression is still controversial in Poland. Not only psychiatrists but also specialists who qualify the patients for ECT--internal medicine specialists, neurologists and anaesthesiologists--treat the advanced age of a patient as a contraindication to ECT. It is also believed that ECT has adverse influence on the mental state of patients with the so-called psychoorganic syndrome. In most centres in Poland ECT is reserved for patients with drug-resistant depression and those in whom pharmacotherapy is contraindicated for any reason, such as pregnancy. Nevertheless the patients are carefully selected with respect to their physical condition. In many countries however the older the patient, the more likely he/she is to receive ECT as a method of choice. The effectiveness of this method in elderly patients is considered to be higher than in younger groups. ECT seems to be particularly effective in depression with psychotic symptoms and psychomotor retardation. The adverse effect of ECT on cognitive functions (learning and memory) which is a great concern of both doctors and patients, is actually noted in a small group of patients and usually transient. Moreover, the frequency of occurrence of this effect in elderly is not greater than in younger patients.

AIM: We have been encouraged to write this paper by very promising results achieved in patients treated with ECT in the Psychogeriatric Ward of the Ist Department of Psychiatry, Medical University of Łódź.

METHOD: All 7 patients were diagnosed with severe depressive episode (in 4 cases with psychotic symptoms) in the course of either recurrent depression (6 cases) or bipolar disorder (1 case).

RESULTS: In all patients at least partial improvement was noted. It seems that ECT, assuming careful patient qualification, is an effective and safe method of therapy in elderly patients.

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