To discuss the effect of electroconvulsive therapy (ECT) on suicide risk in patients with mood disorders.
Method:
A review of the available data on the short-term and long-term effects of ECT on suicide mortality among patients with mood disorders.
Conclusion:
ECT has an acute but not a long-term beneficial effect on suicidality. Due to the significant limitations of studies in this area, however, the data need to be interpreted with caution.
BennettAE. Metrazol convulsive shock therapy in affective psychoses. A follow-up of results obtained in 61 depressive and 9 manic cases. American Journal of Mental Science1939;198:695–701.
2.
SmithLHHughesJHastingsDWAlpersBJ. Electroshock treatment in the psychoses. Am J Psychiatry1942;98:558–61.
3.
MukherjeeSSackeimHASchnurD.Electroconvulsive therapy of acute manic episodes: A review of 50 years' experience. Am J Psychiatry1994;151:169–76.
4.
American Psychiatric Association. Task force on ECT. The practice of ECT: Recommendations for treatment, training and privileging. Washington (DC): American Psychiatric Press; 1990.
5.
WienerRDCoffeyCE. Indications for use of electroconvulsive therapy. In: American Psychiatric Press review of psychiatry. Volume 7. Washington (DC): American Psychiatric Press; 1988.
6.
GoodwinFKJamisonKR. Manic-depressive illness. New York (NY): Oxford University Press; 1990. p 227–44.
7.
AbramsR.Electroconvulsive therapy. New York (NY): Oxford University Press; 1997.
8.
FinkM.Convulsive therapy: Theory and practice. New York (NY): Raven Press; 1979.
9.
IsenbergKEZorumskiCF. Electroconvulsive therapy. In: KaplanHISadockBJ, editors. Comprehensive textbook of Psychiatry. Volume 2. 7th ed.New York (NY): Lippincott Williams and Wilkins; 2000. p 2507–8.
10.
American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 2nd ed.Washington (DC): American Psychiatric Association; 2000.
11.
Canadian Network for Mood and Anxiety Treatments. Guidelines for the diagnosis and pharmacological treatment of depression. Toronto (ON): CANMAT; 1990.
12.
BarracloughBBunchJNelsonBSainsburyP.A hundred cases of suicide: Clinical aspects. Br J Psychiatry1974;125:355–73.
13.
DilsaverSCChenYWSwannACShoaibAMKrajewskiKJ. Suicidality in patients with pure and depressive mania. Am J Psychiatry1993;150:935–40.
14.
AngstJAngstFStassenHH. Suicide risk in patients with major depressive disorder. J Clin Psychiatry1999;60 (Suppl 2):57–62.
15.
Blair-WestGWMellsopGWEyeson-AnnanML. Down-rating lifetime suicide risk in major depression. Acta Psychiatr Scand1997;95:259–63.
16.
HarrisECBarracloughB.Suicide as an outcome for mental disorders. Br J Psychiatry1997;170:205–8.
17.
JamisonKRBaldessariniRJ. Effects of medical interventions on suicidal behavior. J Clin Psychiatry1999;Suppl 2:4–6.
18.
FawcettJScheftnerWClarkDHedekerDGibbonsRCoryellW.Clinical predictors of suicide in patients with major affective disorders: A controlled prospective study. Am J Psychiatry1987;144:35–8.
19.
FawcettJScheftnerWAFoggLClarkDCYoungMAHedekerD.Time-related predictors of suicide in major affective disorder. Am J Psychiatry1990;147:1189–94.
20.
IsometsaETHenrikssonMMAroHMHeikkinenMKuoppasalmiKLonnqvistJK. Suicide in bipolar disorder in Finland. Am J Psychiatry1994;151:1020–4.
21.
IsometsaETHenrikssonMMAroHMHeikkinenMKuoppasalmiKLonnqvistJK. Suicide in psychotic major depression. J Affect Disord1994;31:187–91.
22.
JameisonGR. Suicide and mental disease: A clinical analysis of one hundred cases. Archives of Neurolological Psychiatry1936;36:1–12.
23.
RoyA.Features associated with suicide attempts in depression: A partial replication. J Affect Disord1993;27:35–8.
24.
SchweizerEDeverAClaryC.Suicide upon recovery from depression: A clinical note. J Nerv Ment Dis1988;176:633–6.
25.
SharmaV.Retrospective controlled study of inpatient ECT: Does it prevent suicide?J Affect Disord1999;56:183–7.
26.
ChengA.Mental illness and suicide. Arch Gen Psychiatry1995;52:594–603.
27.
LesageADBoyerRGrunbergFVanierCMoriseetteRMenard-ButeauC, and others. Suicide and mental disorders: A case-control study of young men. Am J Psychiatry1994;151:1063–8.
28.
PrudicJSackeimH.Electroconvulsive therapy and suicide risk. J Clin Psychiatry1999;60 Suppl 2:104–10.
29.
SackeimHADecinaPKanzlerMKerrBMalitzS.Effects of electrode placement on the efficacy of titrated, low-dose ECT. Am J Psychiatry1987;144:1449–55.
30.
SackeimHAPrudicJDevanandDPKierskyJEFitzsimonsLMoodyBJ. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med1993;328:839–46.
31.
RichCLSpikerDGJewellSWNeilJF. Response of energy and suicidal ideation to ECT. J Clin Psychiatry1986;47:31–2.
32.
SackeimHPrudicJDevanandDDecinaPKerrBMalitzS.The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression. J Clin Psychopharmacol1990;10:96–104.
33.
KaragullaS.Evaluation of electric convulsion therapy as compared with conservative methods of treatment in depressive states. Journal of Mental Sciences1950;96:1060–91.
34.
LevySSouthcombeRH. Suicide in a state hospital for the mentally ill. J Nerv Ment Dis1953;117:504–14.
35.
BondEDMorrisH.Results of treatment in psychoses-with a control series. II: Involutional psychotic reaction. Am J Psychiatry1954;110:881–3.
36.
BondEDMorrisH.Results of treatment in psychoses-with a control series. III: Manic-depressive reactions. Am J Psychiatry1954;110:883–7.
37.
ImpastatoD.Electric and chemical convulsive therapy in psychiatry (SCC modified EST. Metrazol and Indoklon convulsive therapy). Diseases of the Nervous System1961;22:91–6.
38.
ZiskindESomerfeld-ZiskindL.Metrazol and electric convulsive therapy of the affective psychoses. Archives of Neurological Psychiatry1945;53:212–7.
39.
HustonPELocherLM. Involutional psychosis: Course when untreated and when treated with electric shock. Archives of Neurological Psychiatry1948;59:385–94.
40.
HustonPELocherLM. Manic-depressive psychosis: Course when untreated and when treated with electric shock. Archives of Neurological Psychiatry1948;60:37–48.
41.
AveryDWinokurG.Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Arch Gen Psychiatry1976;33:1029–37.
42.
AveryDWinokurG.Suicide, attempted suicide, and relapse rates in depression. Arch Gen Psychiatry1978;35:749–53.
43.
TsuangMTDempseyGMFlemingJA. Can ECT prevent premature death and suicide in ‘schizoaffective’ patients?J Affect Disord1979;1:167–71.
44.
BlackDWWinokurGNasrallahAEmmanuelMWoolsonR.Does treatment influence mortality in depressives?Abstract of paper presented at the 141st annual meeting of the American Psychiatric Association1988.
45.
BabigianHMGuttmacherLB. Epidemiologic considerations in electroconvulsive therapy. Arch Gen Psychiatry1984;41:246–53.
46.
BeisserARBlanchetteJE. A study of suicides in a mental hospital. Diseases of the Nervous System1961;22:365–9.
47.
MilsteinVSmallJGSmallIFGreenGE. Does electroconvulsive therapy prevent suicide?Convuls Ther1986;2:3–6.
48.
PhilibertRARichardsLLynchCFWinokurG.Effect of ECT on mortality and clinical outcome in geriatric unipolar depression. J Clin Psychiatry1995;56:390–4.
49.
RoyADraperR.Suicide among psychiatric hospital in-patients. Psychol Med1995;25:199–202.
50.
SolomonMIHellonCP. Suicide and age in Alberta, Canada, 1951–1977, a cohort analysis. Arch Gen Psychiatry1980;37:511–3.
51.
MurphyGEWtezelRD. Suicide risk by birth cohort in the United States, 1949 to 1974. Arch Gen Psychiatry1980;37:519–23.
52.
GoldneyRDKatsikitisM.Cohort analysis of suicide rates in Australia. Arch Gen Psychiatry1983;40:71–4.
53.
BarnesRAEnnisJSchoberR.Cohort analysis of Ontario suicide rates, 1877–1976. Can J Psychiatry1986;31:208–13.
