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Researchers find inadequate evidence of effective electroconvulsive therapy for OCD

Although a systematic review indicated 60% of patients with obsessive-compulsive disorder responded positively to electroconvulsive therapy, researchers conclude the treatment cannot be considered efficacious for obsessive-compulsive disorder due to limited evidence.

“Some [electroconvulsive therapy (ECT)] experts are optimistic about the occasional utility of ECT in treatment-refractory OCD, although this mode of treatment is not mentioned in the official algorithms developed by OCD specialists. Historical reasons, lack of good quality data, and personal experiences may be at the core of this therapeutic inconsistency,” Leonardo F. Fontenelle, MD, PhD, of the Federal University of Rio de Janeiro in Brazil, and colleagues wrote. “Some authors have suggested that defining and characterizing a subset of potential ECT responders should be subject to a definitive controlled study, while others have argued that the burden of experience does not suggest that controlled comparisons would be helpful.”

Researchers conducted a systematic search to identify 50 articles reporting the acute treatment effects of ECT for OCD among a total of 279 patients. Most articles were case reports or series, according to researchers.

Response data were available for 265 study participants, and of these, 60.4% had positive responses to ECT.

Patients who responded to ECT had significantly later onset of OCD symptoms (P = .003), were more frequently nondepressed (P = .009), more commonly treated with ECT for severe OCD (P = .01), and received fewer ECT sessions (P = .03).

Prior, adequate treatment with serotonin reuptake inhibitors (P = .05) or cognitive behavioral therapy (P = .005) was less common among ECT responders.

“In sum, the present state of knowledge suggests that ECT has no role in the routine treatment of OCD. Although nonrandomized and cohort studies, case series, and some single case reports have suggested beneficial effects of ECT in OCD under special circumstances, these studies are limited by a lack of standardized assessment of results, history of less than optimal treatment of OCD, and poorly defined treatment resistance,” the researchers concluded. – by Amanda Oldt

Disclosure: Fontenelle reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.