Question: In adults with a diagnosis of psychotic / delusional depression how effective is electroconvulsive therapy compared to treatment as usual (antidepressants and/or antipsychotics) in achieving improvement of symptoms, relapse rates, admission rates and physical and social functioning?


No definite clinical implications can be made from the available evidence. There is a paucity of randomised controlled trials that evaluate the effectiveness of ECT in comparison with treatment as usual. Only one trial was found in the literature that appeared to address this BEST question. This study, however, compared ECT with combined nortriptyline hydrochloride and lithium carbonate - a treatment which may not be currently used in routine practice. Thus, more studies are required with different study medication combinations (such as a selective serotonin reuptake inhibitor and an anticonvulsant). The authors of the trial further suggested that more research is needed to explore individual patient characteristics (either historical or potential biomarkers) that can be used to predict which patients would do best with the different treatments available. They also suggested that more research is needed to identify effective strategies, including the possibility of combined modalities, for relapse prevention in mood disorders.

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