Is electroconvulsive therapy for depression more effective than placebo? A systematic review of studies since 2009.

Background: A 2010 review of studies and previous reviews and meta-analyses found minimal evidence that ECT for depression was more effective than placebo during the treatment period and no evidence at all of efficacy beyond the end of treatment. The current review explored whether any contradictory evidence has since been generated. Method: MEDLINE and PsycINFO were searched to identify all post 2009 studies that had compared ECT and simulated ECT for depression, or had in any other way generated valid depression data for ECT recipients at two or more points in time. Results: Ninety-one studies met inclusion criteria. There were no new placebo-controlled trials. There have now been no such studies since 1985. Only four placebo-controlled studies have ever produced data beyond the end of treatment, none of which had found any advantage for ECT over placebo. Of the 91 studies only two aimed to evaluate the efficacy of ECT. Both were severely flawed. None of the other 89 produced robust evidence that ECT is effective for depression, primarily because at least 60% maintained ECT participants on medication and 89% produced no meaningful follow up data beyond the end of treatment. No studies investigated whether ECT prevents suicide. Conclusions: There is still no evidence that ECT is more effective than placebo for depression reduction or suicide prevention. Given the 1
well-documented high risk of persistent memory dysfunction, the cost-benefit analysis for ECT remains so poor that its use cannot be scientifically, or ethically, justified.