To Örebro University

OBJECTIVES: Depression is common in the oldest-old population (aged ≥85 years), a population in which research is lacking and the effects of psychopharmacological treatment may be adverse. Electroconvulsive therapy (ECT) appears to be well tolerated by older patients with depression; however, it is used rarely in clinical practice and research concerning the oldest-old is lacking. The objective of this study was to assess response and remission rates, as well as adverse effects, in oldest-old depressed patients treated with ECT.

METHODS: This was a nationwide Swedish register study including 522 oldest-old patients treated with ECT for depression. Two propensity score matched control groups were also included: young patients treated with ECT, and oldest-old depressed patients not treated with ECT. Response and remission rates, clinician-reported adverse events, prognostic factors (including comorbid diseases and treatment parameters), adverse events requiring hospitalization, as well as deaths within 1 week from discharge, were assessed.

RESULTS: The oldest-old receiving ECT reported higher response (81.2%) and remission (53.3%) rates than younger counterparts (67.4% versus 27.4%, respectively). Severe psychotic depression was the only prognostic factor for response and remission. The oldest-old experienced fewer adverse events, most commonly confusion and cardiovascular complications, compared to controls. Compared with oldest-old patients not receiving ECT, the ECT group had fewer hospitalizations following discharge.

CONCLUSION: ECT is a viable treatment option for oldest-old patients with depression, who show higher response and remission rates than younger patients, as well as fewer hospitalizations than oldest-old patients not treated with ECT.