By Niall Hunter-Editor
Electroconvulsive therapy (ECT) is the most effective treatment for depression, particularly when the depression is accompanied by psychotic symptoms or hallucinations, according to new research.
Researchers at the Universities of Edinburgh and Aberdeen also concluded that antidepressant drugs are highly effective and do not, as has been suggested, appear to be associated with an increased risk of suicide.
The researchers state that recent panics about suicidal effects and dependence-inducing potential of antidepressants have tilted the balance of publicly-perceived risk against them, but both their effectiveness and availability make them the likely choice for most patients.
The authors stated that the evidence base for the effectiveness of psychotherapy as a treatment for milder depression or as an adjunct to drugs is thinner than that of drug therapy.
The authors also took issue with recent UK guidelines which did not recommend antidepressants for the initial treatment of mild depression because of a poor risk-benefit ratio.
The authors stated that while there is some evidence of increased suicidal behaviour in the early stages of drug treatment, this does not seem to be linked to a particular drug or class of antidepressant.
On ECT therapy, the researchers said that despite public and professional misgivings, ECT remains the most effective treatment for depression, especially if it presents with psychotic symptoms, such as delusions and hallucinations.
They pointed out however, that there are some risks with ECT, associated with the risks of having general anaesthesia, and of memory impairment.
The researchers, writing in the Lancet journal, said all effective treatments for depression, which by its nature is associated with the most profound suffering, have to be welcomed.
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