Pretreatment differences in specific symptoms and quality of life among depressed inpatients who do and do not receive electroconvulsive therapy: A hypothesis regarding why the elderly are more likely to receive ECT

Electroconvulsive therapy (ECT) is among the most commonly performed medica l procedures requiring general anesthesia in the United States. Nevertheles s, very little is known about the characteristics of depressed patients who receive ECT and how they differ from depressed patients receiving psychotr opic medication. We conducted a detailed examination of demographic, clinic al, and quality-of-life (QOL) measurements in a group of 90 depressed inpat ients, and we then used these measurements to contrast the 31 patients who received ECT with the 59 who received alternative therapies. The ECT group did not differ from the non-ECT group in gender composition, marital status , race, education, employment status, overall severity of depression, chron icity of depression, adequacy of prehospitalization antidepressant treatmen t, extent of physical illness, or extent of social support. The ECT group w as older. Furthermore, the ECT group had greater weight loss, worse functio ning in activities bf daily living (ADLs), and worse functioning in instrum ental activities of daily living (IADLs). The differences in weight loss, A DL, and IADL scores disappeared after age adjustment. However, statistical adjustment for age revealed that the ECT group reported worse capacity in t heir daily living and role functioning than did the non-ECT group. We concl ude that the decision to pursue ECT is based in part on the perceived effec t of the depression on QOL, as well as the severity of specific symptoms su ch as weight loss. The elderly seem particularly vulnerable to depression-r elated functional deficits and weight loss,and this may explain why prior s tudies showed a differential use of ECT in the elderly.