title: Effectiveness of electroconvulsive therapy in community settings.
abstract: BACKGROUND
  Clinical trials indicate that electroconvulsive therapy (ECT) is the most effective treatment for major depression, but its effectiveness in community settings has not been examined.
  
  
  METHODS
  In a prospective, naturalistic study involving 347 patients at seven hospitals, clinical outcomes immediately after ECT and over a 24-week follow-up period were examined in relation to patient characteristics and treatment variables.
  
  
  RESULTS
  The sites differed markedly in patient features and ECT administration but did not differ in clinical outcomes. In contrast to the 70%-90% remission rates expected with ECT, remission rates, depending on criteria, were 30.3%-46.7%. Longer episode duration, comorbid personality disorder, and schizoaffective disorder were associated with poorer outcome. Among remitters, the relapse rate during follow-up was 64.3%. Relapse was more frequent in patients with psychotic depression or comorbid Axis I or Axis II disorders. Only 23.4% of ECT nonremitters had sustained remission during follow-up.
  
  
  CONCLUSIONS
  The remission rate with ECT in community settings is substantially less than that in clinical trials. Providers frequently end the ECT course with the view that patients have benefited fully, yet formal assessment shows significant residual symptoms. Patients who do not remit with ECT have a poor prognosis; this underscores the need to achieve maximal improvement with this modality.
authors.affiliation: Department of Biological Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 126, New York, NY 10032, USA
authors.forename: Joan
authors.initials: J
authors.lastname: Prudic
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
authors.forename: Rice B
authors.initials: RB
authors.lastname: Fuller
authors.forename: Harold A
authors.initials: HA
authors.lastname: Sackeim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003865:Major Depressive Disorder / Q000628:therapy; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome