ArticlePsychological medicine2025
Why is electroconvulsive therapy for depression more effective in older age? A causal mediation analysis.
Article in Psychological medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Psychiatric Association of Türkiye Mood Disorders Section Depression Treatment Guideline - III: Treatment Approach for Depression Subtypes and Special Groups, Psychotherapies, and Psychosocial Interventions.Turk psikiyatri dergisi = Turkish journal of psychiatry · 2026Guideline
- Diverging Trajectories of Depressive Symptoms During Electroconvulsive Therapy: Toward Personalized Treatment.Biological psychiatry global open science · 2026Article
- Microbiome-Informed Precision Electroconvulsive Therapy: Oral-Gut-Immune Signatures and Seizure Biology as Candidate Predictors of Response-A Narrative Review.Biomedicines · 2026Review
- Trials, trips, and tribulations: pathways for implementing psychedelic therapy in Ireland.The international journal of neuropsychopharmacology · 2026Review
- Little information, great impact? A clinical tool for the prediction of electroconvulsive therapy effectiveness in depression.BJPsych open · 2026Article
- Clinical and biological markers of electroconvulsive therapy effectiveness: a narrative review.Translational psychiatry · 2026Review
- Associations Between Thalamic Gray Matter Volume and Psychomotor Symptoms in Major Depressive Disorder: A Voxel-Based Morphometry Study.Neuropsychiatric disease and treatment · 2026Article
- Variables associated with clinical outcomes and switching from unilateral to bitemporal electroconvulsive therapy: a retrospective study.Frontiers in psychiatry · 2025Article
Corrections and comments
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOlder people with depression exhibit better response to electroconvulsive therapy (ECT). We aimed to measure the total effect of age on ECT response and investigate whether this effect is mediated by psychotic features, psychomotor retardation, psychomotor agitation, age of onset, and episode duration.
methodsWe pooled data from four prospective Irish studies where ECT was administered for a major depressive episode (unipolar or bipolar) with baseline score ≥21 on the 24-item Hamilton Depression Rating Scale (HAM-D). The primary outcome was change in HAM-D between baseline and end of treatment. The estimands were total effect of age, estimated using linear regression, and the indirect effects for each putative mediator, estimated using causal mediation analyses.
resultsA total of 256 patients (mean age 57.8 [SD = 14.6], 60.2% female) were included. For every additional 10 years of age, HAM-D was estimated to decrease by a further 1.74 points over the ECT period (
conclusionsA total of 43.1% of the effect of older age on increased ECT response was explained by the mediators. Treatment planning could be improved by preferentially offering ECT to older adults, especially if presenting with psychotic features, greater severity of psychomotor disturbance, and earlier in the episode.
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