The use of electroconvulsive therapy (ECT) en bloc in Denmark: a nationwide register-based study

Abstract

Objective

Electroconvulsive therapy (ECT) en bloc is defined as ECT administered on 2–3 consecutive days. In Denmark, ECT en bloc is recommended for severe conditions such as catatonia, treatment-resistant mania/psychosis, or imminent risk of suicide. To our knowledge, there are no recent reports on the use of ECT en bloc in clinical practice. Here, we provide such a report.

Methods

We characterized the use of ECT en bloc in the period from 2006-2019 based on data from Danish national registers. Furthermore, we compared mortality rates between patients receiving ECT en bloc and patients receiving standard regimen ECT (not en bloc).

Results

We identified 2173 patients who received a total of 2734 ECT en bloc treatment courses in Denmark in the period from 2006 to 2019 (6% of the total number of ECT treatment courses). The use of ECT en bloc was stable over the study period (range: 138–196 patients per year). The most common treatment indications were unipolar depression (41%), psychotic disorder (23%), and bipolar disorder (20%). The vast majority (90%) received ECT en bloc voluntarily. The 1-year mortality rate ratio for ECT en bloc compared to standard regimen ECT was 1.42 (95%CI: 1.03–1.95).

Conclusion

The use of ECT en bloc in Denmark is stable both in terms of the number of patients treated and treatment indications. In keeping with ECT en bloc being used for severe conditions, those receiving this treatment have a higher mortality rate compared to those receiving standard ECT, warranting careful monitoring during follow-up.

Keywords:

• Electroconvulsive therapy
• mental disorders
• mortality
• survival
• registries

Funding

There was no specific funding for this study.

Disclosure statement

CHK reports personal fees from UpToDate, Cambridge University Press, Northwell Health and Psychiatric Times. In addition, CHK has a patent for a bite block for protecting the mouth of patients receiving electroconvulsive therapy (US6098627A). CR received the 2020 Lundbeck Foundation Talent Prize. SDØ received the 2020 Lundbeck Foundation Young Investigator Prize. Furthermore, SDØ owns/has owned units of mutual funds with stock tickers DKIGI, IAIMWC and WEKAFKI, and has owned units of exchange traded funds with stock tickers BATE, TRET, QDV5, QDVH, QDVE, SADM, IQQH, USPY, EXH2, 2B76 and EUNL.

Notes on contributors

Marie I. Pedersen is a medical student at Aarhus University in Denmark.

Estela Salagre is a medical doctor currently working at Aarhus University Hospital - Psychiatry, Aarhus, Denmark.

Charles H. Kellner is a medical doctor currently working at the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.

Christopher Rohde is a medical doctor currently working at Aarhus University Hospital - Psychiatry, Aarhus, Denmark.

Søren D. Østergaard is a medical doctor currently working at Aarhus University Hospital - Psychiatry, Aarhus, Denmark.

Data availability statement

According to Danish Law, the data analyzed in the present study cannot be shared due to the risk of identification of individual patients.