Electroconvulsive therapy (ECT) is a well-established treatment for psychiatric disorders, including depression and psychosis. It is delivered by psychiatrists in a hospital setting. There have also been reports that ECT helps people with Parkinson's disease, both with psychiatric symptoms and with the movement symptoms of the condition. Takamiya and colleagues brought the existing studies together in a systematic review and meta-analysis.
They analysed 14 studies (129 patients). One was a randomised controlled study, 9 were prospective observational studies and 4 were retrospective studies. The authors compared symptoms before and after ECT.
ECT significantly improved motor manifestations in patients with Parkinson's disease, and the improvement was significant in the subpopulation without psychiatric symptoms. It also significantly improved depression and psychosis, and it significantly relieved the wearing-off phenomenon. ECT did not worsen cognitive functioning.
The authors conclude that ECT may have a potential benefit on motor and non-motor symptoms in presumably complicated and difficult-to-treat subgroups. The evidence comes mostly from observational studies and a total of 129 patients, so it is best treated as promising. It is not settled.
ECT is a medical treatment, and decisions about it belong with a psychiatrist and the person's treating team. If you are living with depression, anxiety or another condition, please speak with your GP or a mental health professional about the options available to you.
What the study did
Electroconvulsive therapy (ECT) is a well-established treatment for psychiatric disorders, including depression and psychosis, and it is delivered by psychiatrists. ECT has been reported to be effective for psychiatric symptoms in people with Parkinson's disease (PD), and also for the motor symptoms of the condition. Takamiya and colleagues set out to summarise the clinical studies on the efficacy of ECT for symptoms in patients with PD.
They carried out a systematic review and meta-analysis that included any study design assessing motor or non-motor symptoms before and after ECT. The co-primary outcomes were motor manifestations, assessed using the Unified Parkinson's Disease Rating Scale or other rating scales, and non-motor symptoms, namely depression and psychosis. The secondary outcomes were the wearing-off phenomenon, in which the effect of medication fades before the next dose is due, and cognitive function. The authors compared the severity of symptoms before and after ECT using a random-effects model and expressed the results as standardised mean differences.
What it found
Of 1219 identified citations, 14 studies (n = 129) were analysed. These comprised 1 randomised controlled study, 9 prospective observational studies and 4 retrospective studies.
The findings were as follows. ECT significantly improved motor manifestations in patients with PD, and the improvement was significant in the subpopulation without psychiatric symptoms. ECT significantly improved depression and psychosis. ECT also significantly relieved the wearing-off phenomenon, and it did not worsen cognitive functioning.
The limits
The design of the included studies sets the limits on what can be concluded. Only 1 of the 14 studies was a randomised controlled study. Most were observational, and some were retrospective, which means the data were looked at after the treatment had already been given. This kind of study can suggest a benefit, but it cannot rule out other explanations as reliably as a randomised trial can. The meta-analysis compared symptoms before and after ECT rather than against a comparison group, and the total number of patients was 129.
The authors are measured in their conclusion. They state that the current meta-analysis suggests the potential benefit of ECT on motor and non-motor symptoms in presumably complicated and difficult-to-treat subgroups. The word "potential" is doing real work in that sentence. The abstract does not report how long the benefits lasted or which patients are most likely to respond, so those are best directed to the full paper and to specialist clinicians. Anyone weighing up this treatment should also remember that a meta-analysis of this size cannot predict how any one person will respond.
Why it matters
Parkinson's disease can bring depression, psychosis and treatment complications alongside its movement symptoms, and some of these are difficult to treat. A review that gathers the existing studies in one place, and finds that cognitive functioning was not worsened, gives specialists a clearer picture of where ECT might help and where more research is needed. It also points toward larger, better-controlled studies.
ECT is a medical treatment, delivered by psychiatrists, and it is outside the scope of psychological practice. Anyone considering it should discuss the benefits and risks with a psychiatrist and their wider treating team. If you are living with depression or another mental health condition, speak with your GP or a mental health professional about what support is available. Help is there when you need it.