Drugs and electroconvulsive therapy best treatment for severe depression

Jan 16 2006

According to a new study, despite the fact that over the last decade, two treatments which are often castigated in the media, and have raised both public and professional concern, antidepressants such as Prozac and Seroxat, and electroconvulsive therapy (ECT), remain the most effective treatments for moderate to severe depression.

ECT was first used in 1938 by two Italian physicians to treat seizures in a schizophrenic patient, currently its use is limited to patients suffering from severe depression.

How it works remains unclear but when properly used ECT is effective in treating depression; it is thought that ECT temporarily redirects the electrochemical processes of the brain.

The author Professor Klaus Ebmeier of the University of Edinburgh and three colleagues carried out a review of recent developments and current controversies in the treatment of depression, and say they found that ECT remains the most effective treatment for some.

While psychotherapies are now generally recommended for the treatment of milder depression or as an adjunct to antidepressant drugs in more severe illness, drug treatments remain the mainstay of antidepressant therapy.

But the researchers say ECT, is the most effective treatment especially for patients with psychotic symptoms, such as delusions and hallucinations.

Ebmeier, a psychiatrist, says recent panic in the media suggesting the suicidal effects and dependence-inducing potential of antidepressants have shifted the balance of publicly perceived risk against them, but both their effectiveness and their ready availability, make them the likely choice for most patients.

Figures show that as many as one in six people will at some time in their lives become depressed, which may double their chance of death.

Depression is twice as common in women as in men.

Over 50% of people with depression will become functionally impaired because of their illness, and unfortunately for many a diagnosis of depression is made worse by the social stigma that is still attached to all mental-health illnesses, and makes accessing treatment options difficult and confusing.

The team say that fashionable treatments such as cognitive behavioural therapy, which seeks to teach people how to understand and challenge their negative thoughts, is popular on the basis of the lack of side-effects and patient choice, rather than overwhelming evidence of efficacy.

They argue that the antipathy towards drugs has little evidential support, and shows no increased risk of suicide with Prozac or Seroxat.