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Severe depression can be a life-threatening disorder, especially in
elderly patients. A fast-acting treatment is crucial for this group.
Electroconvulsive therapy (ECT) may work faster than medication.
To compare the speed of remission using ECT v.
medication in elderly in-patients.
The speed of remission in in-patients with a DSM-IV diagnosis of major
depression (baseline MADRS score $20) was compared between 47
participants (mean age 74.0 years, s.d. = 7.4) from an ECT randomised
controlled trial (RCT) and 81 participants (mean age 72.2 years, s.d. =
7.6) from a medication RCT (nortriptyline v.
Mean time to remission was 3.1 weeks (s.d. = 1.1) for the ECT group and
4.0 weeks (s.d. = 1.0) for the medication group; the adjusted hazard
ratio for remission within 5 weeks (ECT v. medication)
was 3.4 (95% CI 1.9–6.2).
Considering the substantially higher speed of remission, ECT deserves a
more prominent position in the treatment of elderly patients with severe