Electroconvulsive Therapy In Late-Life Depression

Abstract Electroconvulsive therapy (ECT) has a special role in the treatment of late-life depression and other psychiatric conditions in the elderly. Compared to those receiving pharmacological treatments, the elderly constitute an especially high proportion of those who receive ECT. For example, a survey of practice in California between 1977 and 1983 indicated that the probability of receiving ECT increased markedly with patient age. While 1.12 persons per 10,000 in the general adult population were treated with ECT, this rate was 3.86 persons per 10,000 people aged 65 years and above (Kramer, 1985). Across diagnoses, Figure 21.1 presents the number of patients treated with ECT in California between 1989 and 1994 as a function of age. (Data for 1993 were not available.) The use of ECT was constant over this period, and the high representation of elderly patients is noteworthy. Similarly, a national survey of inpatient psychiatric facilities conducted by the National Institute of Mental Health (NIMH) indicated that patients aged 61 and older comprised the largest age group receiving ECT (Thompson and Blaine, 1987). In this survey, overall use of ECT had declined substantially in a comparison between the years 1975 and 1980. However, there was no change in the rate of use for inpatients aged 61 years and above. In a follow-up NIMH national survey, Thompson et al. (1994) reported that the use of ECT increased somewhat between 1980 and 1986. Hospital type and age were particularly strong predictors of the use of this modality. Electroconvulsive therapy was far more commonly administered in private general and psychiatric hospitals than in hospitals in the public sector. Individuals aged 65 and older received ECT at a higher rate than persons in any other age group. Indeed, as Figure 21.2 shows, the overall increase in the use of ECT between 1980 and 1986 was fully attributable to its greater use in elderly patients. The national estimate in 1986 was that 15.6% of inpatients with mood disorders received ECT if they were 65 years of age or older, while the rate was only 3.4% among younger inpatients with mood disorder.