Tratamiento electroconvulsivo y depresion


En el numero anterior del NEJM un articulo planteaba el siguiente problema con respecto al tratamiento de la depresion:

Major depressive disorder affects approximately 14 million adults in the United States each year.1 The World Health Organization estimates that, at current rates, depression will be the second most common cause of disability worldwide by 2020.2 Severe depression can impair the quality of life and lead to death by suicide; the lifetime risk of suicide among patients with affective disorders is 6 to 15%. Severe depression also increases the mortality associated with general medical conditions — most notably, heart disease.

Depression in the elderly is a growing public health problem, with an estimated prevalence of 1 to 2% in the general population of elderly persons, 1 to 3% among those living in the community, and 10 to 12% among those in outpatient primary care and inpatient settings.3 Major depression in older adults is a leading cause of disability, and it increases mortality from all causes and the likelihood of placement in a nursing home.4 The risk of suicide is also a serious concern in this population.

Although antidepressant medications are effective for many patients, the rate of response to the first agent administered can be as low as 50%.5 The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial showed that the remission rate decreased from 36.8% to 13.0% as successive treatment steps were required because of nonresponse.6 Outcomes of treatment with antidepressant medications in the elderly may be suboptimal in part because of intolerance of side effects. Also, brain changes in depression in the elderly, especially abnormalities in frontostriatal limbic circuits, can attenuate the response to medications.7,8,9

Pues bien, en el mismo se analiza la efectividad clinica de la terapia electroconvulsiva, la cual en varios trabajos es considerada como más efectiva que el tratamiento farmacologico o la misma psicoterapia. Interesante tema para discutir, sobre todo porque esta vez no se trata de una nueva tecnologia, sino de otra que a más de uno de nosotros siempre nos ha resultado más propia de torturadores que de médicos. Aunque con distintos grados de sutileza, muchas veces uno no nota la diferencia en algunos casos. El Articulo completo se puede leer en este enlace.