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Declining access to electroconvulsive therapy: A clinical choice or an economic one?
Date:1/10/2013

Philadelphia, PA, January 10, 2013 Horrific images from One Flew Over the Cuckoo's Nest notwithstanding, modern electroconvulsive therapy (ECT) remains one of the safest and most effective antidepressant treatments, particularly for patients who do not tolerate antidepressant medications or depression symptoms that have failed to respond to antidepressant medications.

Since its introduction in the 1930s, ECT has evolved into a more refined, but more expensive and extensively regulated clinical procedure. Each treatment involves the assembly of a multidisciplinary clinical team and the use of a highly specialized device to deliver brief pulses of low dose electric currents to the brain. ECT is performed while the patient is under general anesthesia and, depending upon each individual's response, is usually administered 2-3 times a week for 6-12 sessions.

A new study in Biological Psychiatry suggests that reductions in ECT treatment have an economic basis. From 1993 2009, there was a progressive decline in the number of hospitals offering ECT treatment, resulting in an approximately 43% drop in the number of psychiatric inpatients receiving ECT.

Using diagnostic and discharge codes from survey data compiled annually from US hospitals, researchers calculated the annual number of inpatient stays involving ECT and the annual number of hospitals performing the procedure.

Lead author Dr. Brady Case, from Bradley Hospital and Brown University, said, "Our findings document a clear decline in the capacity of US general hospitals which provide the majority of inpatient mental health care in this country to deliver an important treatment for some of their most seriously ill patients. Most Americans admitted to general hospitals for severe recurrent major depression are now being treated in facilities which do not conduct ECT."

This is the consequence of an approximately 15 year trend in which psychiatric units appear
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Contact: Rhiannon Bugno
Biol.Psych@utsouthwestern.edu
214-648-0880
Elsevier
Source:Eurekalert

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