Solution
Anju Lata answered on
May 15 2020
Running Head: CRITICAL LITERATURE REVIEW
CRITICAL LITERATURE REVIEW 2
EVIDENCE-BASED PRACTICE
CRITICAL LITERATURE REVIEW
TOPIC: EFFECTIVENESS OF ECT (ELECTROCONVULSIVE THERAPY) IN TREATMENT OF RESISTANT DEPRESSION
Introduction
Electroconvulsive therapy or electroshock therapy is a psychiatric procedure in which mild electric cu
ent is passed to the
ain of the patient to trigger short instances of seizures with an aim to rectify the mental disorders (Eranti et al, 2007).
Depression is the most recu
ently depicted mental problem in patients of Dementia with a persistence rate of 50% worldwide (University of Oxford,2014). The visible impact of depression in Dementia harnesses the daily activities, deteriorates the life quality and declines the cognitive ability of the patient. Electroconvulsive Therapy is considered as effective in treatment of depression in Dementia however few studies illustrate as ineffective in general mild cases of young patients affecting the cognitive abilities.
The literature review addresses three articles taken from primary and secondary sources.
Identifying the Problem
The treatment of depression through Electroconvulsive Therapy is although effective in remitting the patient from the resistant and long-term depression but after the therapy ends there can be great chances of recu
ence of depression even after consistent administration of pharmacotherapy. The aim of this systematic review is to addresses the effectiveness, benefits, risks and outcomes of continuation electroconvulsive therapy and maintenance electroconvulsive therapy in treatment of patients with depression. The purpose of review is to analyze the importance of therapy in preventing the relapse of depression when compared to traditional antidepressant medicines alone. The study also assesses the cognitive adverse effects of ECT on patients with age greater than 55 and young people, through Mini-Mental State Examination and Montgomery-Åsberg Depression Rating Scale.
Search Strategy
The electronic search of related literature was performed upto April 2018, using Pubmed, Embase, CINAHL and MEDLINE database, with no restrictions of time, language and other constraints. The keywords used in search were (Electroconvulsive Therapy OR ECT OR Continuation Electroconvulsive Therapy OR Maintenance Electroconvulsive Therapy) AND (Electroshock Therapy OR depression OR bipolar disorder) AND ( follow up OR Long Term OR relapse OR mortality).
The search was performed through Keywords to search the results with journal titles, author names, article abstracts and the title. The tags [mh] and [tiab] were used to search the literature with more focus and refinement (University of Michigan Li
ary,2015). The duplicates in the database were eliminated and the eligibility of articles was checked by screening of abstract and the title. The selected articles were screened for full content by independent evaluation of two reviewers. At the instances where the inclusion criteria satisfied with the content of articles, the reviewers retrieved the data from the files. The extracted information was related to continuation therapy, relapse definition, authentic size of sample after every follow up, and overall instances of relapse. The reports were re-evaluated to resolve discrepancies.
The eligibility criteria for the study was: The age of participants must be greater than 18 years, the prospective study would have reported in peer reviewed journals, ECT course would be administered to treat critical depression in patients, the ECT remitters would be followed up for relapse, the relapse would have diagnosed by the clinicians or by using depression scales. The excluded articles were based on the criteria: if the case study involved less than 10 participants, the studies which were retrospective in nature, the prospective study where the relapse rate was determined through proxy or secondary measures like self reported set of responses, or the information retrieved through the family members. The studies involving the reporting of relapse and the effectiveness of treatment were collected only through responses of patients directly having undergone the treatment.
The main outcome was the relapse of symptoms after 6 months of ECT treatment. All the patients who have undergone the ECT treatment follow up long course of medication. We also conducted the relapse rate analysis on Continuous Electroconvulsive Therapy which is used less often than the medicines. C-ECT is generally given to the patients who respond positively to the Electroconvulsive Therapy. The secondary outcomes were the evaluation of relapse rate at 3 months, 1 year and 2 years after the last administration of Electroconvulsive Therapy in the patients who still take antidepressant medicines. To evaluate the efficiency of multiple relapse prevention methods in randomized controlled trials, we calculated the relative risks of recu
ence during multiple periods of 3 months, 1 year and 2 years.
The electronic search retrieved 3421 results, out of which after removing the duplicate data files and ineligible records, 419 articles were retrieved for complete screening. Out of these files, only 71 met the criteria prescribed for inclusion and offered authentic data.
Appraisal of Articles
1. Elias,A., Phutane,V.H., Clarke,S., & Prudice,J.(2018).Electroconvulsive therapy in the continuation and maintenance treatment of depression: Systematic review and meta-analyses. Volume: 52 issue: 5, page(s): 415-424. Australian & New Zealand Journal of Psychiatry. https:
doi.org/10.1177/0004867417743343
The author searched the databases Embase, Medline, PsycINFO and the website clinicaltrials.gov in addition to Cochrane register 2016, for electroconvulsive therapy. The study used two Cochrane reviewers to extract the data as per the guidelines of Systematic review. Four domains of Cochrane collaboration tool were used to assess the risk of bias. The random effect model was implemented to pool the outcomes in the study. The main result as observed was the relapse of depression.
The article involved five studies to include 436 patients in the process of meta-analysis. The analysis reflected that continuation and maintenance therapy along with antidepressant medicines and drugs proved to be helpful in reducing the recu
ence of disease than just the medication used alone for a period of 1 year after consistent administration of electroconvulsive therapy. The treatment by electroconvulsive therapy reflected the risk factor of 0.64 and...