Relief of expressed suicidal intent by ECT: a consortium for research in ECT study.
OBJECTIVE
This study assessed the incidence, severity, and course of expressed suicidal intent in depressed patients who were treated with ECT. The data are from the first phase of an ongoing, collaborative multicenter study, the overall aim of which was to compare continuation ECT with pharmacotherapy in the prevention of relapse after a successful course of ECT.


METHODS
Suicidal intent, as expressed by patients during an interview, was scored at baseline and before each ECT session with item 3 on the 24-item Hamilton Depression Rating Scale in 444 patients with unipolar depression.


RESULTS
One hundred thirty-one patients (29.5%) reported suicidal thoughts and acts (score of 3 or 4) at baseline. Scores decreased to 0 after 1 week (three ECT sessions) in 38.2% of the patients, after 2 weeks (six ECT sessions) in 61.1%, and in 80.9% at the end of the course of treatment.


CONCLUSIONS
Expressed suicidal intent in depressed patients was rapidly relieved with ECT. Evidence-based treatment algorithms for major depressive mood disorders should include dichotomization according to suicide risk, as assessed by interview. For patients at risk, ECT should be considered earlier than at its conventional "last resort" position.
Kellner
Charles H
CH
University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 183 South Orange Ave., F1436, Newark, NJ 07103, USA. kellner@umdnj.edu
Fink
Max
M
Knapp
Rebecca
R
Petrides
Georgios
G
Husain
Mustafa
M
Rummans
Teresa
T
Mueller
Martina
M
Bernstein
Hilary
H
Rasmussen
Keith
K
O'connor
Kevin
K
Smith
Glenn
G
Rush
A John
AJ
Biggs
Melanie
M
McClintock
Shawn
S
Bailine
Samuel
S
Malur
Chitra
C
D000328:Adult; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D000092864:Suicide Prevention
D008094:Lithium; D009661:Nortriptyline