How Effective is the Use of Electronic Convulsive Therapy in Depression in Elderly People?

The fundamental issue that psychiatry is constantly confronted with: confirming that the drugs are effective and, perhaps more importantly, socially accepted. Along these lines, a few variables are critical when considering the documented history of Electronic Convulsive Therapy (ECT) and its influence on modern knowledge and mentalities. The origins of ECT, specialist perspectives and outcomes of the procedure, and the societal consequences of ECT practice are crucial within this framework of knowledge.

Running Head: ECT
How Effective Is the Use of Electronic Convulsive Therapy (ECT) In Depression in Elderly
People?
Student’s Name
Institute’s Name

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ABSTRACT
A 2010 review of trials and previous audits and investigations showed little evidence that
ECT for sorrow was more convincing than sham therapy throughout the treatment period and no
evidence at all of the adequacy after treatment had finished. Whether or not unconnected
evidence has been developed subsequently was the subject of the present audit. All studies
published after 2017-2021 in MEDLINE and PubMed that considered or recreated ECT for
depression or generated genuine information regarding wretchedness for ECT recipients were
searched for in order to identify them in at least two distinct periods. There were no new
preliminaries regulated by bogus therapy. Since 1985, there have been no such investigations.
Four fake treatment-controlled studies have ever supplied information beyond the end of therapy,
and no one found an advantage for ECT over fake treatment in any of these investigations at all.
Only two exams were supposed to look at the effectiveness of ECT. Both were abysmal
in their way. ECT was not shown to be effective for wretchedness in any of the other studies,
mainly because only 60 per cent of ECT participants continued taking medication, and 89 per
cent provided no substantial follow-up information after treatment ended. ECT has never been
tested to see whether it prevents self-destruction. ECT has yet to be shown more effective than a
placebo in treating depression or the prevention of self-destruction. ECT's use cannot be justified
rationally or ethically because of the documented substantial risk of long-term memory loss
associated with the procedure.

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TABLE OF CONTENTS
ABSTRACT....................................................................................................................................2
CHAPTER I: INTRODUCTION.................................................................................................4
1.1 Introduction/Background Context.....................................................................................4
1.2 Research Question.............................................................................................................7
1.3 Aims and Objective...........................................................................................................7
1.4 The Rationale of Study.....................................................................................................7
1.5 Parameters.......................................................................................................................11
1.6 Inclusion/Exclusion Criteria...........................................................................................12
REFERENCES............................................................................................................................14

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How Effective Is the Use of Electronic Convulsive Therapy (ECT) In Depression in Elderly
People?
CHAPTER I: INTRODUCTION
1.1 Introduction/Background Context
The fundamental issues that psychiatry is constantly confronted with: confirming that the
drugs are effective and, perhaps more importantly, socially accepted. Along these lines, a few
variables are critical when considering the documented history of ECT and its influence on
modern knowledge and mentalities. Additionally, the origins of ECT, specialist perspectives and
outcomes of the procedure, and the societal consequences of ECT practice are crucial within this
framework of knowledge. Each component has played a substantial role in the knowledge about
and attitudes concerning ECT held by mental and lay networks members.
These difficulties are deeply ingrained in the societal consequences of their day and have
contributed to modern mentalities and understandings of current medications in psychiatry
during the last many years. As such, these concerns have shaped and continue to shape ECT
practices and are presented in a chronological and narrative format. Electroconvulsive therapy
(ECT) is used to treat a variety of severe and treatment-resistant mental diseases worldwide
(Hermida et al., 2018). According to research, ECT is the most effective and quick treatment for
older adults suffering from depression, bipolar illness, or psychosis (Cepeda et al., 2018). In
addition, ECT can save the lives of individuals with intractable catatonia and neuroleptic
malignant syndrome. Finally, ECT is the safest therapy choice for elderly individuals who cannot
tolerate or respond to drugs and are at a high risk of drug-induced toxicity or hazardous drug
combinations (Read et al., 2018).

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Organic reasons are usually linked to neuropsychiatric disorders like Parkinson's disease,
dementia, and stroke in later life. However, even when these circumstances are present, ECT is
effective. Therefore, ECT as a complementary therapy to improve symptoms to enable
individuals to engage in therapy and avoid symptom relapse and recurrence should be the
priority of study over the next decade (Griffiths and Thompson, 2018).
Electrotherapy (non-convulsive) dates back many centuries to when Scribonius Largus
(about A.D. 47) used an electric eel to cure brain problems (Pandarakalam, 2018). Following
that, advances in electrical science in the late nineteenth century supported the use of power to
treat various clinical and mental conditions. A few associations between illnesses and
psychopathology were found by Pandarakalam (2018). These links paved the way for developing
four critical somatotherapies for the treatment of psychiatric illness between 1933 and 1938.
(Kar, 2019). The following part provides a concise overview of pre-ECT convulsive therapies.
As psychosurgery has a history with important psychiatric therapies, a brief discussion of
attentive mediation in treating dysfunctional behaviour is also included (Hermida et al., 2018).
A therapeutic method used for treatment purposes in which short electric stimuli are
delivered Electroconvulsive therapy (ECT) (Porter et al., 2020). ECT is widely used as one of the
most successful biological treatments for various severe, treatment-refractory, or treatment-
resistant psychiatric diseases, including major depressive disorder (MDD) in Western nations
and schizophrenia in Asian countries. ECT is administered to roughly 100,000 patients in the
United Kingdom each year (Karabatsiakis and Schönfeldt-Lecuona, 2020). In addition, over the
last 20 years, outpatient ECT has been famous as a continuing therapy or a stand-alone acute
course (Tsai, Huang and Lindsey, 2021).

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An increased percentage of ECT use in the senior population might be due to several
causes. First, in multiple investigations, medication was not shown to be more beneficial than
control in treating late-life depression, particularly in depressed individuals with cerebral small-
vessel disease (Porter et al., 2020). Second, senior people have a decreased tolerance to the
medication due to age-related pharmacokinetic changes and greater susceptibility to psychotropic
drugs, like anticholinergic and orthostatic hypotensive side effects. In elderly individuals, ECT
may represent a lower risk of problems than medication (Read and Arnold, 2017). Third, ECT
frequently has a more excellent therapy response in depressed older individuals than in young
ones (Zhang et al., 2018).
ECT is beneficial in treating neuropsychiatric disorders like dissociative symptoms and
Parkinson's disease (Griffiths and Thompson, 2018). However novel neuromodulation
techniques are being researched, ECT is arguably the most generally accessible
nonpharmacologic therapeutic approach for severe mental disorders (Read et al., 2018). Still,
MST's usefulness in the treatment of depression has yet to be proven, even though it has been
linked to quick reorientation and intact anterograde and retrograde memory. Nevertheless, if the
antidepressant efficacy of MST is equivalent to or superior to ECT, and the treatment is FDA
authorised, elderly individuals could benefit from MST for its improved side-effect profile
contrasted to ECT (Read and Arnold, 2017).
The administration of ECT is restricted due to negative cognitive consequences. Research
on decreasing cognitive side effects and putting electrodes near some anatomical parts of the
brain that are effectively relevant to mood and behaviour despite preserving learning, memory,
and cognition persists (Zhang et al., 2018). A good example is the FEAST trial. As discussed
previously in this paper, a marked supra threshold dosage enhances ECT effectiveness but causes

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more severe acute or short-term cognitive adverse effects (Kalisova et al., 2018). Future clinical
and academic investigations must concentrate on how and when to use ECT as a potent
synergistic therapy to complement other biological and psychological treatments and avoid
symptom regression or incidence (Griffiths and Thompson, 2018).
1.2 Research Question
The research question for this study is “How Effective Is the Use of Electronic
Convulsive Therapy (ECT) In Depression in Elderly People”.
1.3 Aims and Objective
The study aims to analyse the effectiveness of Electronic Convulsive Therapy (ECT) for
older adults suffering from depression. Moreover, the study is focused on the identification of the
purpose for which ECT is used worldwide. The study is based on the following objectives:
 To evaluate the application of Electronic Convulsive Therapy (ECT) for older adults
suffering from depression.
 To analyse the effectiveness of the ECT therapy on older adults.
1.4 The Rationale of Study
Many individuals who undergo electroconvulsive therapy (ECT) experience late-life
unhappiness due to their treatment (Read and Arnold, 2017). Elderly individuals in the United
Kingdom's emergency clinics who were found to be suffering from substantial intermittent pain
were more likely to get ECT than those between the ages of 18 and 34. (Avasthi and Grover,
2018). There are a few factors that contribute to the increased usage of ECT in elderly suffering

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patients. Patients over the age of 50 are more vulnerable to the adverse effects of psychotropic
medications and may be less willing to undergo a beneficial upper medicine pre-treatment
(Popiolek et al., 2019). In addition, the elderly are more likely to have underlying medical
disorders that might complicate the use of upper medication or affect the response to
pharmacological therapy.
The aim for which this study has been conducted is of great significance. As a result, the
study will assist in analysing the effectiveness of Electronic Convulsive Therapy (ECT) for older
adults suffering from depression. In comparison to those who did not get ECT, researchers
determined that those who had ECT had a significantly reduced impact of fibromyalgia, a
significant reduction in depressive symptoms, and a minor decrease in the degree of physical
suffering (Read et al., 2018). Therefore, the research help identify various aspects which would
help researchers to work in the field of psychology. This study adheres to interpretative research
philosophy, which implies that humanity may be comprehended in a subjective manner (Cepeda
et al., 2018). Understanding the patterns through which individuals experience social interactions
is given the highest importance here. This research philosophy is based on regulations that state
that the scholar plays a specific function in observing society.
As per interpretative philosophy, the study is based on the researcher's interests (Read et
al., 2018). The study's research questions were evaluated based on the findings of other
researchers' investigations. To get an understanding regarding the study objectives, primary
sources on the subject were gathered and analysed. The research questions are assessed regarding
the implications, processes, benefits, and limitations of Electronic Convulsive Therapy (ECT)
effectiveness for older adults suffering from depression. Throughout the study, the positivism
approach has been utilised. The philosophy research aims to define the timeline and respective

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tasks to be completed. Positivism implies that knowledge comes separate from the object of
study. It indicates that the interpretation of concepts is constant amongst subjects in practice
(Badran, 2019).
Perceptions may influence the qualitative information gathering. Member perception is a
well-known approach for personal data collection. While member perception is very valid, it
requires repeatability because of the difficulty of reproducing the investigation identically.
There are several techniques for manipulating member perception, and it often demands the
professional to adopt the way of life or location being observed. Member perception is often
longitudinal; the analyst must devote significant time to the centre gathering to get a "local's
viewpoint." Member perception may be guided either explicitly or implicitly, depending on the
exploration's objective. Secretive member perception refers to the expert hiding their true
identity and the participants' cognitive processes behind their research. This approach is
effective in socially sensitive areas, such as degenerate or criminal subcultures, where an expert
might acquire subjective assessment techniques (Read and Arnold, 2017).
A keyword-based examination of the published literature was accompanied by an
examination and interpretation of accessible textual studies to gather relevant data for this
investigation. A thorough examination of the data collected or an assessment of all available
information. The information now accessible can be used to discover the exact answer to a
given situation. The way data is collected and then evaluated is based on the methodological
approach used for the study (Cepeda et al., 2018). To examine the validity and reliability of the
data, choosing a suitable methodological approach is essential. The collected data, irrespective
of the strategy used for the study, is categorised as primary and secondary data. The primary
data is driven from direct sources, whereas the secondary data is driven by the work and

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opinions of other authors (Dinwiddie, 2019). The PRISMA Flow diagram for this research is
shown in Figure 1.
Figure 1. PRISMA Flow Diagram
1.5 Parameters
The study's essential data was gathered using electronic databases. Along with its
accessibility and dependability, information technology is frequently employed. For example,

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Google Scholar is a search engine that assists one in finding articles that are valuable to the
current study. The data were analysed utilising comparison and inclusion parameters. In addition,
the study points out that many networking sites help identify essential people in the area studied.
The study also emphasises the need for high-level data collection for a database-driven, cost-
intensive research database (Dinwiddie, 2019).
As a result, the second approach has been determined to be the most suited method for
this research (Saleem et al., 2018). The evaluation of several studies on this issue has shown
different results based on numerous writers' viewpoints and interpretations, and observational
bias has been observed along with bias in terms of sources that different authors have utilised.
Therefore, the literature search has been completed within the mentioned timeframe with the
most effective outcomes. It has also been ensured that no data is being shared between the
different members of the team collected from various secondary resources (Read et al., 2018).
The experimental research on older adults regarding the ECT, case studies, action
research, interviews, and surveys through primary qualitative methods can all be used as part of
the process. Regarding the ECT patients, the research approach is determined by the aim of this
research study. As a result, this research has been carried out successfully based on the
viewpoints of numerous writers chosen for the specified research subject within the domain of
research parameters (Griffiths and Thompson, 2018).
To achieve the aim of the study, the researcher analysed the studies on the effectiveness
of Electronic Convulsive Therapy (ECT) for older adults suffering from depression. Evidence is
collected, chosen, synthesised, and analysed throughout the assessment process to meet the
study's goal. The approaches may evaluate and practice using evidence-based research as they
find weaknesses in the research design that could be addressed (Griffiths and Thompson, 2018).

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The information gathered for evaluation must be appropriate for testing by using a set of
standardised procedures. According to these precise criteria, information analysis could offer
such responses regarding the research questions and the findings from the assessment of the
underlying evaluation evidence (Cepeda et al., 2018).
1.6 Inclusion/Exclusion Criteria
In the current time, there has been a shift in the significance of studies in this sector.
Different global journal publications, including IEEE, Google Scholar, Cinhle, Research Gate,
Science Direct, Emerald Insights, and others, were used as data sources. The necessary data was
taken from the articles cited. Google Scholar is a credible source from which the essential
information is gathered and used within this paper. Moreover, there has been an aim to gather
primary data sources to save time and commitment whilst finding valuable insights to finish the
study within the deadline. As a result, several publications presented in-depth information as
well as preliminary conclusions.
In order to put forward comprehensive research, the study must include some inclusion
and exclusion criteria with the help of the PICO/PEO model. These criteria help researchers to
identify the research gaps and limitations of the study. In addition, inclusion criteria lead to the
evaluation of the research question so that the study's aims and objectives are met effectively
(Dinwiddie, 2019). Demographic, physiological, and regional factors are standard inclusion
criteria for this study. In contrast, exclusion criteria help researchers identify additional traits of
the study so that the study's effectiveness can be enhanced and the likelihood of adverse
outcomes can be minimised. Researchers must choose the appropriate inclusion and exclusion

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criteria when doing research and examine how those decisions may impact the results' external
credibility (Read et al., 2018).

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