title: Electroconvulsive therapy for obsessive-compulsive disorder: a systematic review.
abstract: OBJECTIVE
  Surgical therapies for treatment-refractory obsessive-compulsive disorder (OCD), such as deep brain stimulation or psychosurgery, remain unattainable for many patients. Despite the long-held view that electroconvulsive therapy (ECT) is an ineffective treatment for OCD, there is no systematic review to support or refute this claim, which is the basis of the current review.
  
  
  METHODS
  A systematic search of MEDLINE, Web of Science, Scopus, and LILACS databases was conducted on December 22, 2013, using the terms obsessive-compulsive disorder and electroconvulsive therapy. Reference lists, specific journals, and clinical trial registries were also scrutinized. No date or language limitation was imposed on the search.
  
  
  METHODS
  After irrelevant and redundant records from the 500 identified titles were excluded, the 50 articles reporting the acute treatment effects of ECT in OCD and related constructs (involving a total of 279 patients) were analyzed for this study.
  
  
  METHODS
  The relevant sociodemographic, clinical, and outcome data of individual cases were extracted. Data from individual cases were used to compare the characteristics of responders versus nonresponders to ECT.
  
  
  RESULTS
  Most selected records were case reports/series; there were no randomized controlled trials. A positive response was reported in 60.4% of the 265 cases in which individual responses to ECT were available. ECT responders exhibited a significantly later onset of OCD symptoms (P = .003), were more frequently nondepressed (P = .009), more commonly reported being treated with ECT for severe OCD (P = .01), and received a fewer number of ECT sessions (P = .03). ECT responders were also less frequently previously treated with adequate trials of serotonin reuptake inhibitors (P = .05) and cognitive-behavioral therapy (P = .005).
  
  
  CONCLUSIONS
  Although 60% of the reported cases reviewed exhibited some form of a positive response to ECT, it cannot be stated that this provides evidence that ECT is indeed effective for OCD.
authors.affiliation: Rua Visconde de Pirajá, 547, Sala 617, Ipanema, Rio de Janeiro, CEP: 22410-003 lfontenelle@gmail.com.
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Fontenelle
authors.forename: Evandro S F
authors.initials: ES
authors.lastname: Coutinho
authors.forename: Natália M
authors.initials: NM
authors.lastname: Lins-Martins
authors.forename: Paul B
authors.initials: PB
authors.lastname: Fitzgerald
authors.forename: Hironobo
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Murat
authors.initials: M
authors.lastname: Yücel
mesh_terms: D004565:Electroconvulsive Therapy / Q000379:methods*; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D016896:Treatment Outcome