Friday, February 2, 2018

ECT Said to Be Underutilized to Treat Major Depression, Bipolar Disorder

Despite its effectiveness in treating severe depression, the use of electroconvulsive therapy (ECT) is “exceptionally uncommon and limited to patients with extensive multimorbidity,” according to a report published Thursday in Psychiatric Services in Advance.

Samuel Wilkinson, M.D., of Yale School of Medicine and colleagues compared the sociodemographic and clinical characteristics of privately insured Americans with major depressive or bipolar disorder who received ECT and those who did not.

The authors found that among the selected individuals in the 2014 MarketScan commercial insurance claims database (N=47,258,528), the ECT utilization rate was 5.56 ECT patients per 100,000 in the population. Of the 969,277 patients with major depression or bipolar disorder, 2,471 (0.25%) received ECT.

Those who received ECT had substantially higher rates of comorbid psychiatric disorders, higher numbers of prescription fills for any psychotropic medication, higher rates of any substance use disorder, and total outpatient psychotherapy visits. States in the west region had significantly lower ECT rates. The disparity was accounted for by strict legal requirements for ECT in one of the states in that region.

“Whereas standard antidepressant therapies achieve response with 16%-17% of patients with treatment-resistant depression, ECT achieves response rates of 50%-70% with such patients. Recent data show that among psychiatric inpatients, ECT is associated with a 46% lower risk of 30-day readmission compared with a matched group of patients with severe depression who did not receive ECT,” Wilkinson and colleagues wrote.

“Given what we know about the prevalence of treatment-resistant depression (TRD), our study suggests that less than 1% of these patients receive ECT,” Wilkinson told Psychiatric News. “Defining an ‘appropriate’ rate of utilization can be challenging. [But to only use for] 1% of TRD patients and 0.25% of patients with major depression or bipolar disorder is significant underutilization.”

Wilkerson and his colleagues noted that underutilization of ECT is thought to reflect a combination of factors, including stigma, risk of cognitive side effects, and restricted access because of limited availability.

For more on this topic, see the Psychiatric News article “Psychiatric Readmissions Lower Among Patients Receiving ECT.”

(Image: iStock/shapecharge)


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