TABLE 2.
Summary of ECT study characteristics
| Study | Study design | Stimulus dose administration | Number of sessions | Frequency of treatment | Analysis | Primary Outcome | Results/Authors' conclusions | Evidence (PEDro) | |
|---|---|---|---|---|---|---|---|---|---|
| Kellner et al. (2005) | A nonblinded randomized trial | a Thymatron DGx device | Treatment group: 13 sessions | ECT group | PT group | Baseline, 1st w, 2nd w | 24‐HDRS | Expressed suicidal intent in depressed patients could be rapidly relieved with ECT. | Level 1b |
| Control group: 3 sessions+PT (nortriptyline+lithium) | Acute phase | Acute phase | |||||||
| 1st w: 3 sessions | 1st w: 3 sessions | ||||||||
| Continuation ECT | Continuation PT | ||||||||
| 2nd−5th w: 1 session/w | nortriptyline+lithium | ||||||||
| 6th−13th w: 1 sessions/2 w | |||||||||
| The following 2 m: 1 session/m | |||||||||
| Brådvik and Berglund (2006) | A retrospective study | Unknown | ECT group: at least 6 sessions | ECT group: 3 sessions/w | After 28 years and 32 years | / | Occurrence of suicidal attempt: ECT+continuation treatment with ATD<ECT<ATD. Seriousness of suicide attempt: ECT>ATD. | Level 3 | |
| ECT+continuation treatment with ATD group: 6 sessions | ECT+continuation treatment with antidepressant group: 3 sessions/w during 2 weeks+continuation with ATD | ||||||||
| Liang et al. (2017) | A nationwide retrospective cohort study | Unknown | Unknown | Unknown | From 1 January 2000 to 31 December 2013 | / | Suicide events: ECT group<Non‐ECT group | Level 3 | |
| Cumulative risk of suicide: ECT group<Non‐ECT group (All patients with AD). Cumulative risk of suicide: ECT group<Non‐ECT group (Patients with UD). Cumulative risk of suicide: ECT group=Non‐ECT group (Patients with BD). | |||||||||
| Ahmadi et al. (2015) | A retrospective nested matched case–control study | A Thymatron IV ECT device | 6 ± 1 sessions | 3 sessions/week | Baseline, 12th week | CGI‐S, CGI‐C | The suicide rate: 2.2% in ECT group and 5.9% in ATD group | Level 3 | |
| The relative‐risk of suicidality was 64% less in MDD and PTSD with ECT treatment compared to those without ECT. | |||||||||
| Keshtkar et al. (2011) | A nonblinded randomized trial | ECT group: (MECTA Corporation model device) | 10 sessions (ECT or rTMS) | ECT group | rTMS group | Preintervention and postintervention | HDRS, BDI | The decrease in the score of suicide in the short term: ECT>rTMS. | Level 1b |
| rTMS group: 90%RMT, Frequency: 10 Hz for either 2s or 6s, Train: 20s | 3 sessions/w | 1 session/d | |||||||
| Patel et al. (2006) | A retrospective study | A Thymatron System IV | 5–10 sessions | 3 sessions/w | Pre‐ECT and post‐ECT | 24‐BPRS | Efficacy of suicide for depressive patients: ECT>control group. | Level 3 | |
| Ciapparelli et al. (2001) | A prospective controlled study | MECTA Corporation model device | MM: 7.2 ± 1.7 sessions; BD: 7.3 ± 1.6 sessions | 2 sessions/w | T0, T1, T2 | MADRS, BPRS, CGI‐S | The decrease in suicidality: MM>BD from T0 to T2. | Level 2 | |
| Veltman et al. (2018) | A prospective controlled study | A Thymatron System IV | 4 sessions | 2 sessions/w | Baseline, 1st w, 2nd w | MADRS | Suicidality showed significant improvement in w 1 as compared with baseline. | Level 2 | |
| Hunt et al. (2011) | A retrospective study | Unknown | Unknown | Unknown | In 2011 | / | The fall in the use of ECT has not affected suicide rates in patients receiving this treatment. | Level 3 | |
| Munk‐Olsen et al. (2007) | A register‐based cohort study | Unknown | Unknown | Unknown | In 2007 | / | Patients who had received ECT had a slightly higher suicide rate, especially within the first 7 days after the last ECT treatment. | Level 3 | |
| Popiolek et al. (2018) | A retrospective study | Unknown | 5.8 ± 5.3 sessions | Unknown | From January 2011 to December 2014 | / | Patients treated with cECT had a similar risk of suicide attempt or completed suicide to those who did not receive cECT. | Level 3 | |
| Black et al. (2016) | A retrospective study | Unknown | Unknown | Unknown | From January 1970 to December 1981 | From a short‐term follow‐up of depressives that ECT received in the hospital has minimal influence on subsequent mortality, including suicide. | Level 3 | ||
| Brunoni, et al. (2013) | A multicenter nonblinded randomized trial | The Mecta Spectrum 5000Q device and a Thymatron System IV | 29 sessions | Weekly cECT for 6 weeks and thereafter every 2 weeks for 46 additional weeks, a total of 29 ECTs for the full year. | The patients were recruited between 10 January 2008 and 22 March 2012. Follow‐up was completed on 29 May 2012. | One suspected suicide and 3 suicide attempts by intoxication occurred, all in the PT‐alone group. | Level 2 | ||
| Avery and Winokur (1978) | A prospective study | / | Unknown | Unknown | From 1959 to 1960 and from 1967 to 1968 | Suicide attempts were seen significantly less frequently in the ECT groups than in the ATD group or the "adequate" ATD subgroup. Fewer suicide attempts occurred in the ECT group compared to the ATD group among both in those who had attempted suicide prior to admission (0% versus 10%) and in those who had not (1.1% versus 3.6%). | Level 2 | ||
Abbreviations: AD, Affective disorders; ATD, Antidepressant; BD, Bipolar disorder; BDI, Beck Depression Inventory; 24‐BPRS, 24‐item Brief Psychiatric Rating Scale; CGI‐C, Clinician Global Impressions‐Change scale; CGI‐S, Clinician‐rated global illness severity; ECT, Electroconvulsive Therapy; HDRS, Hamilton depression scale; MADRS, Montgomery–Asberg Depression Rating Scale; MM, mixed mania; RCT, randomized controlled trial; T0, the day before starting ECT; T1, 48 hr after completion of the 3rd session; T2, a week after the last session; PEDro, the Physiotherapy Evidence Database tool; PT, pharmacotherapy; UD, unipolar disorder.