Comparison of Electroconvulsive Therapy and Antidepressants

Comparison of Electroconvulsive Therapy and AntidepressantsBrief 101151 accessionDepression is unitary of the more than than harsh forms of mental illness. It has been estimated that approximately 9.5% of the community pass on suffer with slack at any one magazine (Robins and Regier 1990) and that 17% of hatful will suffer with first at whatsoever point in their life (Blazer et al 1994). Defining natural depression is non a straight forward task. This is due to the fact that it behind endure from normal unhappiness through persistent and pervasive ways of emotion and thinking to psychosis (Hale 1997). Having verbalize this, a itemise of different features which washbasin be associated with depression reach been identified by Hale (1997)Persistent blue moodLoss of interest and enjoymentReduced energy and haggard activityPoor concentration and attentionLow self reckon and low confidenceIdeas of guilt and unworthinessBleak pessimistic views of the proxIdeas or act s of self harm or suicideDisturbed pileDiminished appetiteIt is also possible to distinguish between tercet major types of depression. The first form of depression is Dysthymia which involves immense- destination inveterate depressive symptoms which do non necessarily disable the individual. The second form is bipolar Disorder which involves the patient experiencing periods of mania and depression through cycles of mood change. The tierce and final category concerns Major Depression. The symptoms involve with this mental illness go to ensure that it is difficult for the patient to work, study or to enjoy activities as well as them having difficulties regarding eating and sleeping patterns. It is this ordinal and most drab form of depression which will be the concentrate on of the following discussion. give-and-take OF SEVERE DEPRESSIONA number of different cash advancees to the handling of depression take up been taken which ar based on a turn over of theoretical persp ectives. These acknowledge approaches such as Cognitive Behavioural Therapy, psychoanalysis and those based on increasing exercise levels. However, perhaps the most common treatment for depression involves the using up of antidepressant drug drugs (Ameri mass Psychiatric Association 1993) These acknowledge medications such as Tricyclic (which is cheap and effective but does have expression make which limit compliance), Selective Serotonin Up-Take Inhibitors (which has fewer side effects but less effective for disturbed sleep) and Monoamine (which, in r atomic number 18fied movements, squirt be fatal when mixed with certain foods) Although antidepressants can be effective, look for has indicated that they whitethorn not be the optimal solution. For example, Thomas et al (1982) conducted a study involving 115 participants who were randomly eachocated to receive either a combination of antidepressants or a placebo. The medication was found to have a world-shaking effect but non-compliance was identified as a meaning(a) problem. It has been estimated that non-compliance regarding antidepressant drugs is between 20 and 59% (Johnson 1973 and Thomas et al 1982). notwithstanding look into has also describe that patients who atomic number 18 suffering with depression are still at a epoch-making risk of relapse or recurring symptoms even when they have been adhering to their medication programme for a long period of magazine (Grunhaus et al 1990). It whitethorn also be the wooing that medication is not suitable for all forms of depression. For example, Hale (1997) suggested that antidepressants whitethorn not be effective for psychotic depression. Therefore, as a result of the potentiality drawbacks of non-compliance, relapse and not being effective for all forms of depression, efforts have been do to identify other approaches for the treatment of loathsome depression.One of the most disputable treatment approaches is Electroconvulsive Therapy ( e lectroshock therapy). It was first apply in 1938 by Cerletti and Bini (Linington and Harris 1988). It involves sending an electric current through the patients brain with the aim of bear on the release of neurotransmitters which will ultimately improve the patients mood. electroconvulsive therapy has obtained a somewhat negative reputation due to stories of bitten tongues and fractured bones and it is practically seen as a form of punishment quite a than treatment. However, look backs of its application have demonstrated that electroshock does have significant returnss compared to simulated ECT, when all procedures are followed without an electrical current actually being given (The UK ECT reexamination Group 2003). Whenever one is making decisions regarding the use of any given treatments, one must consider the clay of scientific evidence which has assessed the treatments efficacy and potentiality. The following retread will aim to consider the query which has assessed the efficacy and effectiveness of ECT as a treatment for tough depression in order to determine its effectiveness with reference to the use of antidepressants.RESEARCH QUESTIONThus, the following check out will aim to get along the question Is ECT an effective treatment compared with antidepressants in cases of difficult depression. The methodology which was employed within this question will now be outlined.LITERATURE SEARCHA opinionated review aims to integrate alive information from a comprehensive range of sources, utilising a scientific replicable approach, which gives a balanced view, hence minimising bias. It can also be stated that systematic reviews provide a means of integrating valid information from the question literature to provide a basis for rational decision making concerning the provision of healthcare.2.1 SOURCES OF DATAThe methodology employed within the research involved obtaining data from three break sources Computerised searches, Manual searches, an d the Internet. Each of these data sources will now be considered in more detail.2.11 COMPUTERISED SEARCHESThe methods used in this research will include a detailed computerised literature search. Multiple databases, both online and CDRom will be accessed to retrieve literature because they course credit the majority of relevant texts. The computerised bibliographic databases are-MEDLINEEMBASECINAHLPSYCHINFOBiological AbstractsCochraneSIGLEHowever because articles may not be correctly indexed within the computerised databases, other strategies will be applied in order to achieve a comprehensive search.2.1.2 manual of arms SEARCHESA manual search will be performed to ensure that all relevant literature is accessed. The manual searches will include-Books relevant to the things from university libraries and weather vane sitesInverse searching- by locating index terms of relevant ledger articles and textsSystematically searching reference lists and bibliographies of relevant journa l articles and texts2.1.3 THE INTERNETThe net income will provide a global perspective of the research topic and a searchable database of Internet files collected by a computer.Sites accessed will include-Department of Health home(a) Institute of Clinical Excellence face National Board of Nursing, Midwifery and Health VisitingGoogleBritish medical journal2.2 IDENTIFICATION OF KEY WORDSA bent-grass of key spoken language will be used within the literature search. Elements of the research question will be used to provide the search terms. Therefore, the words Electroconvulsive Therapy, Antidepressants, Depression, strengthiveness and Evaluation will all be used.2.3 INCLUSION AND excision CRITERIATo ensure that the more relevant research studies are identified, a set of inclusion and exclusion criteria will be utilised. In order to be included in this research the studies will need to relate to the military rank of Electroconvulsive Therapy and relate to the treatment of depressi on. Furthermore, studies will be excluded if they are published in the beginning 1975 or if they are not usable in English.DISCUSSIONThis review has identified literature which has focussed on assessing the effectiveness of ECT in comparison to antidepressants regarding the treatment of severe depression. In order to structure the discussion, the research will be analysed with reference to the benefits of ECT regarding relapse, patients who are drug-resistant and those with severe depression in particular. The potential drawbacks of ECT will then be shortly considered before overall conclusions are drawn regarding the research question.3.1 RELAPSEStudies were dictated which highlighted the benefits of ECT regarding the reduction of relapse. For instance, Petrides et al (1994) reviewed the case histories of 33 patients who had been diagnosed with long term depression. A set of 21 patients were included in the study as a one category follow up report was available for analysis. Ea ch of the participating patients had been taking antidepressants for a significant length of time but were still experiencing relapses of depression. After the delivery of ECT it was reported that the number of patients with depression who suffered relapses fell from a normal rate of 50% to 33% at the one year follow up. For the patients with delusional depression in particular, the relapse figure fell from a normal rate of 95% to 42%. Based on this research it would appear that ECT can be more effective than antidepressants in terms of reducing relapse grade.A more recent and relevant study was conducted by Gagne et al (2000) which also involved the retrospective reviewing of patients notes. Two groupings of 29 matched participants were identified. The first group had only been taking antidepressants were as the second group had antidepressants along with ECT. At the two year follow up stage the relapse rates for those who had ECT was 52% compared to the 93% associated with those who only had medication. At the five year follow up stage, the relapse rate for the drug-only group had fallen slenderly to 73% where as the ECT group had fallen dramatically to vindicatory 18%. The average survival rate of the ECT group was 6.9 geezerhood which was significantly longer than the 2.7 years for the drug-only group. Therefore the research considered in this percentage would lead one to conclude that ECT can be more effective than antidepressants alone in terms of reducing relapse rates. Having said this, it should be noted that these research projects involved combining ECT with antidepressants rather than replacing them entirely.3.2 MEDICATION RESISTANT PATIENTSAlthough antidepressants are effective for many patients with depression, on that point are some groups for whom it is less effective. Rabheru and Persad (1997) reviewed the literature which focused on assessing the effectiveness of ECT for patients who were found to be resistant to antidepressant medicat ion. They found that the research evidence indicated that ECT could have significant benefits for medication resistant patients. These benefits were curiously relevant for elderly patients with depression. An important point to make here, however, was demonstrated by research conducted by Prudic et al (1996). They reported that the effectiveness of ECT may aggravate as the time for which the patient has suffered with severe depression increases. Therefore, the approach of using ECT when the patient has been found to be resistant to antidepressants may not be the optimal approach as the possible benefits of ECT may have been reduced. Therefore, this section has demonstrated that ECT could be unspoilt for patients who have severe depression and have not been significantly helped by the use of antidepressants. However, it is important to note that the use of ECT may decline over time.3.3 PATIENTS WITH SEVERE DEPRESSIONFurther research has indicated that ECT may well have particular benefits over antidepressants with regards to patients who have severe depression. Sobin et al (1996) conducted research to evaluate the effectiveness of ECT for patients with a range of levels of depression. They reported that 70% of the participants responded significantly as a result of the ECT and that significant improvements were make by those who had severe depression. Other research has also leant run for the assertion that ECT is particularly beneficial for patients with severe depressive symptoms, mood congruent delusions and those who are at prominent risk of committing suicide (Martin 1989, Schatzberg 1992, Persad 1990, Philibert et al 1995 and concede et al 1996). It appears that the attributes of ECT are particularly suited to the treatment of people with severe depression. It may be that the more severe a mortals depressive symptoms are, the more drastic and severe the treatment approaches need to be for them to be effective.CONCLUSIONSThis review has considered re search which has investigated whether ECT is effective in treating severe depression when compared to antidepressant drugs. Based on this research it can be concluded that ECT, when combined with antidepressants, does appear to significantly reduce patients relapse rates. It can also be said that the evidence supports the view that ECT can be effective for patients who have been found to be resistant to antidepressants. The third and final conclusion is that ECT appears to be particularly suited to patients with the more severe forms of depression. Having said this, some criticisms need to be acknowledged regarding this body of research. For instance, Rose et al (2003) highlighted three major drawbacks. Firstly 1 in 3 patients who are given ECT report persistent entrepot loss. Secondly, the research studies conducted by clinicians in this area report more decreed results than those conducted by consumer agencies. This may be due to the selection of participants or the focus of the research questions. The third and final drawback outlined by Rose et al (2003) is that the studies which support ECT rarely assess the long term effects or cognitive functioning and the majority of them were conducted many years past using small exemplifications. The research is also limited because it mainly uses case studies (Thienhaus et al 1990), naturalistic studies (Aronson et al 1987) or retrospective reviews of patient notes (Stiebel 1995). some randomly controlled trials were highlighted by this literature search. Such criticisms must be unploughed in mind when considering the effectiveness of ECT in comparison to antidepressants for treating severe depression.5.0 IMPLICATIONS FOR PRACTICEGuidelines produced by the National Institute of Clinical Excellence, based on a review of Department of Health and Cochrane database research, recommends that ECT be used for rapid and short term improvements for patients with severe depression or who are at significant risk of suic ide (Tharyan and Adams 2003). However, as highlighted by the regal College of Psychiatrists (2003) in their response to these guidelines, the use of ECT may have a wider scope than this approach would suggest and the guidelines may ensure that patients who may benefit from ECT are not given the treatment. Further research in this area will provide a basis upon which to test the appropriateness of these guidelines and the current use of ECT. It would appear that ECT can have significant benefits for patients with severe depression but that more efforts need to be made to tackle the negative impressions which may be associated with this treatment such that it can become a more accepted approach. The main implication of this review for practice is that ECT appears to have a significant role to tinker in the treatment of severe depression but that it is likely to be alongside the use of antidepressants rather than instead of them. This strategy will alter the most comprehensive trea tment programme to be delivered to the patients and ensure that their chances of a full recovery are maximised.REFERENCESAmerican Psychiatric Association (1993). hold guidelines for major depressive disorder in adults. American Journal of abnormal psychology 150(suppl) 4.Aronson TA, Shukla S, and Hoff A (1987) Continuation therapy after ECT for delusional depression a naturalistic study of prophylactic treatments and relapse. 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