Electroconvulsive Therapy Linked to Significant Decrease in Suicide Risk Among Severe Depression Patients

A recent comprehensive analysis has revealed that individuals suffering from severe depression who undergo electroconvulsive therapy (ECT) exhibit a 34% lower likelihood of dying by suicide compared to those receiving standard treatment options, such as antidepressant medications.

This meta-analysis, which synthesizes data from multiple previous studies, represents a pioneering effort to establish a substantial reduction in suicide risk associated with ECT. The research also indicates that patients undergoing ECT experienced a 30% decrease in mortality from all causes, suggesting additional health advantages beyond mental health.

The research team from the University Psychiatric Clinics Basel in Switzerland evaluated high-quality studies examining the impact of various brain stimulation therapies on suicidal thoughts and behaviors in individuals diagnosed with depression. Their findings are published in the journal Neuroscience Applied.

Dr. Timur Liwinski, the lead researcher, noted that this analysis is the first to highlight the survival benefits of ECT for patients suffering from depression. The study reinforces that ECT remains the most effective treatment option available for severe cases of depression, while also demonstrating reductions in both suicide rates and overall mortality.

Depression, classified as Major Depressive Disorder (MDD), currently affects approximately 300 million individuals globally, with a notable increase of around 20% reported between 2005 and 2015. The full implications of the COVID-19 pandemic on global mental health continue to be evaluated. Each year, close to 700,000 individuals succumb to suicide, marking it as the fourth leading cause of death among young people aged 15 to 29. A significant portion of these suicides--around half--are associated with depression or related mood disorders, with affected individuals facing a twenty-fold increased risk of suicide.

This study consolidates high-quality data from earlier research focused on neurostimulation therapies for patients with depression who do not respond to traditional treatment modalities, such as selective serotonin reuptake inhibitors (SSRIs). Approximately one-third of patients with major depression fall into this category of treatment resistance.

The research team analyzed the effects of three neurostimulation techniques: Electroconvulsive Therapy (ECT), repetitive Transcranial Magnetic Stimulation (rTMS), and Vagus Nerve Stimulation (VNS), on suicidal behavior among individuals with depression. From an initial pool of 1,352 scientific studies, 26 studies meeting strict quality and inclusion criteria were selected, all of which reported on treatment methods, suicide rates, suicidal ideation, and overall mortality metrics.

Among the selected studies, eleven specifically focused on ECT, comparing a total of 17,890 individuals treated with ECT against 25,367 individuals receiving conventional care. The analysis revealed 208 suicide deaths within the ECT group compared to 988 in the control group. Furthermore, all-cause mortality was significantly lower in the ECT group, with 511 deaths compared to 1,325 in the control group.

The researchers concluded that patients treated with ECT were 34% less likely to die by suicide and had a 30% lower risk of death from any cause when compared to those receiving standard treatment options. Additionally, a moderate reduction in suicidal thoughts was observed among patients undergoing ECT.

For rTMS, the available data were insufficient to draw definitive conclusions, as small-scale studies did not demonstrate a significant impact on suicidal ideation or suicide rates. Patients undergoing VNS appeared to experience a 60% reduction in overall mortality, although the small sample sizes raise questions about the reliability of these findings. In contrast to ECT, which has been utilized in clinical settings since the 1930s, rTMS and VNS are relatively recent treatments, and the body of evidence supporting their efficacy is still evolving. The researchers advised caution against making broad generalizations based on current data.

Dr. Liwinski further noted that newer studies tend to report greater benefits from ECT than older ones, likely due to advancements in treatment methodologies over time. As the analysis spans several decades, it is plausible that contemporary ECT offers even greater protective effects against suicide than the 34% reduction identified overall.

While most of the studies included in this analysis were observational rather than experimental, limiting the certainty of the evidence, the vulnerability of individuals with severe depression and suicidal ideation suggests that high-quality experimental studies may be challenging to conduct in the future.

Professor Martin Balslev Jørgensen, a psychiatrist from the Psychiatric Center Copenhagen and the University of Copenhagen, commented on the importance of this study, stating that the documented effects of ECT on suicidality, while known within clinical circles, benefit from clear documentation. The observed reductions in all-cause mortality, which have been consistently reported, may indicate an unidentified life-extending mechanism; however, this is likely attributable to patient selection factors.