Successful ECT in long-term care residents

INTRODUCTION: Depression is common in long-term care (LTC) residents and causes increased mortality and morbidity. Treatment resistance or intolerance to antidepressants is not unusual. Electroconvulsive therapy (ECT) is a safe and effective alternative for older community-dwelling residents but has not been well studied in LTC residents. METHODS: A retrospective chart review was made of all LTC residents who received ECT from a single academic 538-bed facility over a 3-year period. Demographic information, severity of medical illness as measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), psychiatric diagnosis, earlier psychotropic drug trials, and MMSE before and after ECT were collected. ECT therapy was reviewed for number and types of treatments and complications. Outcome after ECT was rated with the Clinical Global Impression of Change scale (CGI). RESULTS: Thirteen patients (4 men, 9 women ), mean age 81 years (range: 65-95), received ECT. All had a diagnosis of major depression, and 10 had associated psychotic features. All patients received at least two psychotropic agents before receiving ECT (range: 2-11). Patients also had significant medical comorbidity, with a mean (CIRS-G) of 19.7 (range: 14-27). On average, patients received 5.7 ECT treatments in the hospital (range: 3-10), and 9 of 13 patients received bilateral stimuli. Nine patients (69%) were rated as improved, two (15%) were clinically unchanged, and two (15%) were rated as worse. Complications included transient atrial fibrillation in one patient, posttreatment headache in one patient, and delirium in one patient. Five patients had transient cognitive decline as measured by the MMSE, but all recovered fully by 1 month. CONCLUSIONS: ECT was a safe and effective treatment modality in this population of LTC residents with a significant medical comorbidity. 69% of patients exhibited clinical improvement despite previous medication resistance. Careful monitoring for delirium in this population is essential to prevent more protracted posttreatment confusion.