Understanding electroconvulsive therapy‐related anxiety: a prospective study

Aims of study Although electroconvulsive therapy (ECT)‐related anxiety is experienced by a significant proportion of patients, it remains understudied. Our aim was to study the course of ECT‐related anxiety during ECT. Methods Seventy‐four patients with unipolar or bipolar depression, referred for ECT, were included. ECT‐related anxiety was assessed the morning before each ECT session using the ECT‐related Anxiety Questionnaire (ERAQ). Results Female patients reported more anxiety than men (F(1,64.6) = 3.95, P = 0.05). Patients with a psychotic depression were more anxious before the start of ECT (F(64.8) = 4.57, P = 0.04), but experienced a significant decrease in ECT‐related anxiety (t(63.9) = −3.63, P = 0.0006), whereas patients with a non‐psychotic depression remained stable on anxiety during their ECT course (t(63,9) = 0.76, P = 0.45). In addition, we found a significant correlation between the decrease of ECT‐related anxiety and the decrease of depression‐severity (r = 0.35; P = 0.04). Conclusion There are individual differences in ECT‐related anxiety trajectories during ECT. Both female patients and patients with psychotic depression experienced more ECT‐related anxiety before the start of ECT. The severity of ECT‐related anxiety decreased significantly in patients with a psychotic depression, but remained stable in patients without a psychotic depression during ECT. In addition, patients who showed a stronger decrease in depression‐severity also showed a stronger decrease in ECT‐related anxiety. A better understanding of ECT‐related anxiety trajectories can help in designing anxiety‐reducing interventions.