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Is ECT effective in severe depression?

Quality assessmentSummary of findingsImportance
No. of patientsEffectQuality
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsComparisons involving ECTControlRelative (95% CI)Absolute
Low-dose bilateral ECT vs low-dose unilateral ECT - non-responders
4randomised trialsno serious limitationsserious1no serious indirectnessvery serious2none51/98 (52%)83/119 (69.7%)RR 0.65 (0.35 to 1.21)24 fewer per 100 (from 45 fewer to 15 more)[plus sign in circle]○○○
VERY LOW
67.9%24 fewer per 100 (from 44 fewer to 14 more)
Low-dose bilateral ECT vs low-dose unilateral ECT - non-remission
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone43/67 (64.2%)46/67(68.7%)RR 0.93 (0.77 to 1.14)5 fewer per 100 (from 16 fewer to 10 more)[plus sign in circle][plus sign in circle][plus sign in circle][plus sign in circle]
HIGH
57.8%4 fewer per 100 (from 13 fewer to 8 more)
Low-dose bilateral vs low-dose unilateral - mean endpoint depression scores (Better indicated by lower values)
2randomised trialsno serious limitationsserious1no serious indirectnessvery serious2none4942-SMD 0.46 lower (1.69 lower to 0.76 higher)[plus sign in circle]○○○
VERY LOW
Low-dose bilateral ECT vs high-dose unilateral ECT - non-responders
7randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone63/179 (35.2%)66/183 (36.1%)RR 0.98 (0.74 to 1.29)1 fewer per 100 (from 9 fewer to 10 more)[plus sign in circle][plus sign in circle][plus sign in circle][plus sign in circle]
HIGH
38.5%1 fewer per 100 (from 10 fewer to 11 more)
Low-dose bilateral ECT vs high-dose unilateral ECT - non-remission
5randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none62/118 (52.5%)51/119 (42.9%)RR 1.24 (0.97 to 1.6)10 more per 100 (from 1 fewer to 26 more)[plus sign in circle][plus sign in circle][plus sign in circle]
MODERATE
31.8%8 more per 100 (from 1 fewer to 19 more)
Bilateral ECT (low dose) vs high-dose unilateral ECT - mean endpoint scores (Better indicated by lower values)
4randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none10797-SMD 0.01 higher (0.27 lower to 0.29 higher)[plus sign in circle][plus sign in circle][plus sign in circle]
MODERATE
1

Significant heterogeneity - random effects model used

2

Inconclusive effect size

Significant heterogeneity - random effects model used

Inconclusive effect size

From: APPENDIX 16, CLINICAL EVIDENCE PROFILES

Cover of Depression
Depression: The Treatment and Management of Depression in Adults (Updated Edition).
NICE Clinical Guidelines, No. 90.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2010.
Copyright © The British Psychological Society & The Royal College of Psychiatrists, 2010.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the British Psychological Society.

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