title: Influence of age on effectiveness and tolerability of electroconvulsive therapy.
abstract: OBJECTIVE
  The effectiveness of electroconvulsive therapy (ECT) in pharmacotherapy-resistant major depressive disorder and schizophrenia has been shown for all age groups. Nevertheless, age-specific adverse effects such as greater cognitive impairment and higher somatic risks due to medical comorbidities and concomitant medication may be limiting factors in geriatric patients.
  
  
  METHODS
  We retrospectively evaluated 4457 treatments in 380 patients to investigate the influence of age on ECT outcome, safety, and adverse effects. Clinical variables, treatment modalities, and neurophysiological parameters were analyzed. For modeling the influence of age on these variables of interest, linear and logistic regression models were performed.
  
  
  RESULTS
  The mean (SD) age of our patients was 51.2 (15) years; 30% were older than 60 years. Diagnoses were major depressive disorder in 74.4% and schizophrenia in 25.6%. We found a considerable clinical improvement in all age groups. A higher severity of disease at admission corresponded to a better clinical response. Analyzing treatment modalities of elderly patients older than 60 years, no significant differences in need and number of concomitant psychotropic medications were seen, but significant differences were seen in medical co-medication. Ictal and postictal neurophysiological parameters were only in part predictive for clinical outcome, but age had a significant influence on most of them. Transient cardiovascular adverse effects and cognitive disturbances were more frequent in the elderly. In most cases, there was no need for any specific treatment.
  
  
  CONCLUSIONS
  Our data confirm previous studies indicating the good effectiveness of ECT irrespective of age. We also found an excellent tolerability profile in the elderly in our patient sample. There was no mortality, and only transient and no life-threatening adverse events occurred.
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany. Julia.Damm@med.uni-muenchen.de
authors.forename: Julia
authors.initials: J
authors.lastname: Damm
authors.forename: Daniela
authors.initials: D
authors.lastname: Eser
authors.forename: Cornelius
authors.initials: C
authors.lastname: Schüle
authors.forename: Michael
authors.initials: M
authors.lastname: Obermeier
authors.forename: Hans-Jüergen
authors.initials: HJ
authors.lastname: Möller
authors.forename: Rainer
authors.initials: R
authors.lastname: Rupprecht
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Baghai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000758:Anesthesia; D004565:Electroconvulsive Therapy / Q000009:adverse effects; D004569:Electroencephalography; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D012640:Seizures / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult