A prospective follow-up study of ECT outcome in older depressed patients

Background: This study examined the relationship between age and outcome of electroconvulsive therapy (ECT). Method: This was a naturalistic, prospect ive follow-up of 81 consecutive in-patients with primary major depression. ECT outcome was compared for three age groups - under 65, 65-74 and 75 year s and over - on the Hamilton Rating Scale for Depression (HRSD), Global Ass essment of Functioning scale (GAF) and clinical outcome rating scale. Asses sments were performed pre-ECT, immediately post-ECT, 1-3 years later and, f or patients suspected of having dementia, 5 years later. Results: At post-E CT and follow-up, improvement on HRSD and clinical outcome ratings were com parable for patients in the three age groups. Improvements on GAF were also comparable post-ECT, but not between post-ECT and follow-up. At follow-up, 35.7% of the oldest group had dementia. Importantly, patients who did and did not develop dementia were clinically indistinguishable prior to ECT. Th e number and severity of common adverse events were similar pre- and post-E CT and were not associated with age. Conclusions: Depressive outcome and ad verse effects of ECT are largely independent of age. Older patients receivi ng ECT appear to have a higher risk of developing dementia, possibly underp inned by cerebrovascular disease. (C) 2000 Elsevier Science B.V. All rights reserved.