Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication

Br J Psychiatry. 2015 Jan;206(1):67-71. doi: 10.1192/bjp.bp.114.148213. Epub 2014 Oct 16.


Background: 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.

Aims: To compare the speed of remission using ECT v. medication in elderly in-patients.

Method: 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. venlafaxine).

Results: 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).

Conclusions: Considering the substantially higher speed of remission, ECT deserves a more prominent position in the treatment of elderly patients with severe depression.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Antidepressive Agents, Second-Generation / therapeutic use
  • Cyclohexanols / therapeutic use*
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / therapy*
  • Electroconvulsive Therapy*
  • Female
  • Humans
  • Male
  • Nortriptyline / therapeutic use*
  • Remission Induction
  • Time Factors
  • Treatment Outcome
  • Venlafaxine Hydrochloride


  • Antidepressive Agents, Second-Generation
  • Cyclohexanols
  • Venlafaxine Hydrochloride
  • Nortriptyline