A new study determines that very few depression patients receive the treatment once known as 'shock therapy,' which today uses far milder electrical impulses than decades ago. Researchers suggest that the modern form of the approach called ECT should be made more available to patients who fail to get relief from two other types of treatment, such as antidepressant medications and talk therapy. Its findings could inform depression care decisions by insurers and policymakers, as well as conversations between doctors and patients. The study was published in JAMA Psychiatry.

The researchers used data from recent, highly regarded clinical studies to create a simulation of patients' potential journeys through many depression treatment strategies. But for patients whose depression symptoms didn't ease after trying two different treatments – what psychiatrists call "treatment resistant" depression ECT emerged as a cost-effective choice.

Short for electroconvulsive therapy, ECT delivers brief, mild electrical impulses to the brain under short-term anesthesia. Although it may require more specialized care, opting for ECT as a third-line option could be cost-effective compared to other treatments, and it may significantly reduce the time that patients spend with depression symptoms, the study finds.

Present study

Researchers showed that just 0.16% of VA patients who had depression nationwide received ECT. Their study also revealed wide variations in the use of ECT by region, and by the race and medical health status of the patient. Other more recent studies have shown that patients receive ECT only after trying five to seven different antidepressants, and other medications.

The model also used data from ECT clinical trials. It took a conservative approach based on those findings that assumed that half of the patients who try ECT would get immediate and full relief, also called remission, though one-third might relapse after a year. ECT treatment regimens start with multiple sessions in the first few weeks, often followed by a brief or longer-term maintenance schedule.

After that, STAR*D found diminishing returns: a third antidepressant-based treatment only helped about 155 of those who failed to get relief from the first two options they tried, and a fourth option only helped 7 to 105 of patients. The U-M team's model suggests that instead of spending half of the four years after diagnosis of active depression symptoms, patients could be symptom-free two-thirds of the time.

Future Study

The team had not expected ECT to come out as cost-effective for the third-line use they had expected this to be true for fifth- to sixth-line treatment. The findings suggest that if patients and physicians decide to try a third, fourth or fifth antidepressant or psychotherapy course and therapy before they opt for ECT.

The new findings might also help physicians make the case to patients' insurers that ECT should be covered earlier in a treatment-resistant depression patient's course. They should not allow the stigma attached to the past incarnations of this approach to prevent its modern form from being seriously considered for appropriate patients.