Posttraumatic stress disorder (PTSD) is associated with a high burden of disability and mortality and frequently is treatment resistant. There is little to offer patients who are not responding to standard interventions. Thus, the objective of this report is to systematically review human data on whether electroconvulsive therapy (ECT) is effective in PTSD.
Methods
We performed a systematic literature review from 1958 through August 2016 for clinical studies and case reports published in English examining the efficacy of ECT in improving PTSD symptoms.
Results
The literature search generated 3 retrospective studies, 1 prospective uncontrolled clinical trial, and 5 case reports. It is not clear, given the small sample size and lack of a large randomized trial, whether favorable outcomes were attributed to improvement in depression (as opposed to core PTSD symptoms).
Conclusions
Current efficacy data do not separate conclusively the effects of ECT on PTSD symptoms from those on depression. Randomized controlled trials are necessary to examine the use of ECT in medication-refractory PTSD patients with and without comorbid depression. Subsequent studies may address response in PTSD subtypes, and the use of novel techniques, such as memory reactivation, before ECT.
Get full access to this article
View all access options for this article.
References
1.
KesslerRCBerglundPDemlerO. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.
2.
KesslerRUstunTB eds. The WHO World mental health surveys: global perspectives on the epidemiology of mental disorders. New York, NY: Cambridge University Press; 2008.
3.
DavidsonJRHughesDBlazerDG. Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med. 1991;21:713–721.
4.
Amaya-JacksonLDavidsonJRHughesDC. Functional impairment and utilization of services associated with posttraumatic stress in the community. J Trauma Stress. 1999;12:709–724.
5.
ThomasJLWilkJERiviereLA. Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Arch Gen Psychiatry. 2010;67:614–623.
6.
KesslerRCSonnegaABrometE. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048–1060.
7.
ShalevAYFreedmanSPeriT. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry. 1998;155:630–637.
8.
GuerraVSCalhoun PS; Mid-Atlantic Mental Illness Research Education and Clinical Center Workgroup. Examining the relation between posttraumatic stress disorder and suicidal ideation in an OEF/OIF veteran sample. J Anxiety Disord. 2011;25:12–18.
9.
NockMKHwangISampsonNA. Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15:868–876.
10.
WilcoxHCStorrCLBreslauN.Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Arch Gen Psychiatry. 2009;66:305–311.
11.
DedertEAGreenKTCalhounPS. Association of trauma exposure with psychiatric morbidity in military veterans who have served since September 11, 2001. J Psychiatr Res.2009;43:830–836.
12.
CalhounPSBosworthHBGrambowSC. Medical service utilization by veterans seeking help for posttraumatic stress disorder. Am J Psychiatry. 2002;159:2081–2086.
13.
AmielJMMangurianCVGanguliR. Addressing cardiometabolic risk during treatment with antipsychotic medications. Curr Opin Psychiatry. 2008;21:613–618.
14.
BergerWMendlowiczMVMarques-PortellaC. Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33:169–180.
15.
HertzbergMAFeldmanMEBeckhamJC. Lack of efficacy for fluoxetine in PTSD: a placebo controlled trial in combat veterans. Ann Clin Psychiatry. 2000;12: 101–105.
16.
DavidsonJRWeislerRHButterfieldMI. Mirtazapine vs. placebo in posttraumatic stress disorder: a pilot trial. Biol Psychiatry. 2003;53:188–191.
17.
HoskinsMPearceJBethellA. Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. Br J Psychiatry. 2015;206:93–100.
18.
BradyKPearlsteinTAsnisGM. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA. 2000;283:1837–1844.
19.
SchwartzACRothbaumBO. Review of sertraline in post-traumatic stress disorder. Expert Opin Pharmacother. 2002;3:1489–1499.
20.
MarshallRDLewis-FernandezRBlancoC. A controlled trial of paroxetine for chronic PTSD, dissociation, and interpersonal problems in mostly minority adults. Depress Anxiety. 2007;24:77–84.
21.
TuckerPZaninelliRYehudaR. Paroxetine in the treatment of chronic posttraumatic stress disorder: results of a placebo-controlled, flexible-dosage trial. J Clin Psychiatry. 2001;62:860–868.
22.
YoussefNAMarxCEBradfordDW. An openlabel pilot study of aripiprazole for male and female veterans with chronic post-traumatic stress disorder who respond suboptimally to antidepressants. Int Clin Psychopharmacol. 2012;27:191–196.
23.
RaskindMAPetersonKWilliamsT. A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry. 2013;170:1003–1010.
24.
TaylorFBMartinPThompsonC. Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. Biol Psychiatry. 2008;63:629–632.
25.
CusackKJonasDEFornerisCA. Psychological treatments for adults with posttraumatic stress disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2016;43:128–141.
26.
LisanbySH. Electroconvulsive therapy for depression. N Engl J Med. 2007;357:1939–1945.
27.
ÖzdemirB, GaripB, ÖznurT, . Post-traumatic stress disorder and comorbid psychotic disorder: electroconvulsive therapy response in two Patients. Bulletin of Clinical Psychopharmacology. 2013;23:373–377.
28.
MargoobMAAliZAndradeC.Efficacy of ECT in chronic, severe, antidepressant- and CBT-refractory PTSD: an open, prospective study. Brain Stimul. 2010;3:28–35.
29.
WattsBV. Electroconvulsive therapy for comorbid major depressive disorder and posttraumatic stress disorder. J ECT. 2007;23:93–95.
30.
ForbesDCreamerMBiddleD.The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behav Res Ther. 2001;39:977–986.
31.
MontgomerySAAsbergM.A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–389.
32.
AhmadiNMossLSimonE. Efficacy and long-term clinical outcome of comorbid posttraumatic stress disorder and major depressive disorder after electroconvulsive therapy. Depress Anxiety. 2016;33:640–647.
33.
HelsleySSheikhTKimKY. ECT therapy in PTSD. Am J Psychiatry. 1999;156:494–495.
34.
HanrettaATMalek-AhmadiP.Combined use of ECT with duloxetine and olanzapine: a case report. J ECT. 2006;22:139–141.
35.
GahrMSchönfeldt-LecuonaCSpitzerM. Electroconvulsive therapy and posttraumatic stress disorder: first experience with conversationbased reactivation of traumatic memory contents and subsequent ECT-mediated impairment of reconsolidation. J Neuropsychiatry Clin Neurosci. 2014; 26:E38-E39.
36.
BlakeDDWeathersFWNagyLM. The development of a Clinician-Administered PTSD Scale. J Trauma Stress. 1995;8:75–90.
37.
BeckATSteerRABrownGK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.
38.
HamiltonM.A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.
39.
SchwabeLNaderKWolfOT. Neural signature of reconsolidation impairments by propranolol in humans. Biol Psychiatry. 2012;71:380–386.
40.
DavidsonJRRothbaumBO van der Kolk BA, . Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry. 2001;58:485–492.
41.
DavidsonJRTharwaniHMConnorKM. Davidson Trauma Scale (DTS): normative scores in the general population and effect sizes in placebo-controlled SSRI trials. Depress Anxiety. 2002;15:75–78.
42.
MarshallRDBeebeKLOldhamM. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry. 2001;158:1982–1988.
43.
YoussefNAMcCallWV. Relapse prevention after index electroconvulsive therapy in treatmentresistant depression. Ann Clin Psychiatry. 2014;26: 288–296.
