Is the Use of Electroconvulsive Therapy Falling Because of Fewer Referrals of Patients With Severe Depression?

Background: The reasons for the fall in the use of electroconvulsive therapy (ECT) in the United Kingdom have never been systematically assessed. Between 2005 and 2006, the Edinburgh clinic saw the greatest fall ever in the rate of ECT usage between consecutive years. Objective: To test the anecdotal hypothesis that this fall resulted from the referral of fewer patients with a diagnosis of severe depression (with or without psychotic symptoms) as per the International Classification of Diseases, 10th Revision. Diagnostic data from 2007 were included to aid comparison. Results: The rates of ECT usage (number of individual patients treated per 10,000 total population) were 1.33, 0.82, and 0.88 in the study years. The numbers of patients with a diagnosis of severe depression of either type were identical in the study years. The fall in the rate of ECT usage resulted mainly from fewer referred patients with a diagnosis of other mood disorders, that is, disorders that did not meet criteria for more specific diagnoses such as depressive episode or bipolar affective disorder. Conclusions: Just as many severely depressed patients were treated despite the marked fall in the rate of ECT usage.