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

to be discontinuing use of the procedure. The percentage of hospitals with psychiatric units which conduct ECT dropped from about 55% in 1993 to 35% in 2009, which has led to large reductions in the number of inpatients receiving ECT.

Analyses of treatment for inpatients with severe, recurrent depression indicate the changes have equally affected inpatients with indications like psychotic depression and with relative medical contraindications, suggesting declines have been clinically indiscriminate. By contrast, non-clinical patient factors like residence in a poor neighborhood and lack of private insurance have remained important predictors of whether patients' treating hospitals conduct ECT, raising the concern of systemic barriers to ECT for the disadvantaged.

Where hospitals have continued to conduct the procedure, use has remained stable, indicating divergence in the care of patients treated in the large academic facilities most likely to conduct ECT and those treated elsewhere.

"Psychiatry has taken a step backward. The suffering and disability associated with antidepressant-resistant depression constitute a profound burden on the patient, their family, and society. ECT remains the gold standard treatment for treatment-resistant depression," commented Dr. John Krystal, Editor of Biological Psychiatry. "We must insure that patients with the greatest need for definitive treatment have access to this type of care. ECT may be one of the oldest treatments for depression, but its role in treatment has been given new life in light of a generation of research that has outlined molecular signatures of ECT's antidepressant efficacy."


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Contact: Rhiannon Bugno
Biol.Psych@utsouthwestern.edu
214-648-0880
Elsevier
Source:Eurekalert

Page: 1 2

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