Health-related quality of life following ECT in a large community sample

While electroconvulsive therapy (ECT) is a potent antidepressant, little is known about its long-term effects on health-related quality of life (HRQOL). Using a naturalistic, observational design, 283 depressed patients, who received ECT at 7 hospitals in the New York City area, were assessed for HRQOL with the Medical Outcomes Study Short Form - 36 (SF-36) at baseline, several days after ECT, and 24 weeks later. Depression severity was assessed with the Hamilton Rating Scale for Depression, and a neuropsychological battery was also administered. Baseline SF-36 scores were very low, indicating poor HRQOL. These scores were improved at postECT and at the 24-week follow-up. Unexpectedly, the degree of retrograde amnesia for autobiographical information was associated with better HRQOL in the immediate postECT period, but not at 24-week follow-up. In contrast, improvement in global cognitive status was associated with superior HRQOL at the 24-week time point. This study was limited by the lack of a non-ECT comparison group, and the naturalistic design of treatment. ECT is associated with improved HRQOL in the short- and long-term, with the enhancements largely explained by improvements in depressive symptoms. The acute cognitive effects of ECT may also influence HRQOL assessment, and evaluations removed in time from the treatment may have greater validity.