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Drugs, 'Shock Therapy' Beat Depression

Study Shows ECT and Antidepressants Are Effective Therapies
By
WebMD Health News
Reviewed by Louise Chang, MD

Jan. 12, 2006 - Some of the most maligned therapies for depression are also the most useful, say researchers whose review of depression treatments appears in the latest issue of The Lancet.

The researchers concluded that electroconvulsive therapy, once known as "shock treatment," and antidepressant drugs are the most effective treatments for moderate to severe depression.

Psychiatry professor Klaus P. Ebmeier, MD, of the University of Edinburgh and colleagues reviewed developments in depression research within the last five years, focusing on recent advances and controversies.

They found that most patients improve with current treatments, although depression remains a widely undertreated condition.

The Drug Debate

A spate of recent news reports has questioned both the usefulness and safety of drug treatments for depression.

One of the most widely reported was the public spat between actor Tom Cruise and actress Brooke Shields last summer. Cruise publicly criticized Shields for taking selective serotonin reuptake inhibitor (SSRI) antidepressants to treat her postpartum depression after the birth of her first child.

Cruise called antidepressants "very dangerous" and claimed that there was no proof that chemical imbalances in the brain drive depression. Shields responded in a newspaper column, calling Cruise's assertions a "ridiculous rant."

Antidepressants and Suicide

Questions about whether SSRI use is associated with an increased risk of suicidal behavior in adults and children have also been much in the news.

Studies suggesting a link, especially in young people, prompted officials in the U.K. to conclude that antidepressants should not be used for the initial treatment of mild depression, and most SSRIs have been banned in Great Britain for use by children and teens.

In the U.S., the FDA ruled in 2004 that packaging for SSRI drugs must include a warning that patients taking them should be closely monitored for suicidal behavior.

Ebmeier and colleagues conclude that there is little unbiased scientific evidence to back up claims that the new-generation antidepressants are linked to suicides, adding that the moves by the regulatory agencies in the U.K. and U.S. are not justified.

"Recent moral panics about suicidal effects and dependence-inducing potential of antidepressants have tilted the balance of publicly perceived risk against them, but both their effectiveness and their ready availability make them the likely choice for most patients," they write.

Shock Therapy Revisited

The reviewers call electroconvulsive therapy (ECT) “the most effective treatment for depression, especially if patients present with psychotic symptoms, such as delusions and hallucinations.”

Max Fink, MD, who is widely known as “the grandfather of American ECT,” tells WebMD that studies continue to show that the treatment is highly effective in depressed patients with psychosis.

He says ECT was all but abandoned in the 1960s when antidepressant drugs became available, but they found a following once again in the 1980s as a treatment for severely depressed patients who did not respond to drugs.

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