Browse > Article
http://dx.doi.org/10.22857/kjbp.2020.27.2.004

The Electroconvulsive Therapy in the Prevention of Suicide Risks and Attempts  

Kim, Hee Cheol (Department of Psychiatry, Keimyung University School of Medicine)
Jeong, Seong Hoon (Department of Psychiatry, Eulji University Hospital)
Ahn, Yong Min (Department of Psychiatry and Institute of Human Behavioral Medicine, National University Hospital, Seoul National University College of Medicine)
Park, Seung Hyun (Daedong Hospital)
Kim, Yong Sik (Department of Psychiatry, Nowon Eulji University Hospital)
Chung, In Won (Department of Psychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital)
Publication Information
Korean Journal of Biological Psychiatry / v.27, no.2, 2020 , pp. 64-73 More about this Journal
Abstract
Suicidality is the most serious complication of mood disorders and psychosis; effective treatment should reduce suicide rates. The Organization for Economic Cooperation and Development age-standardized suicide rate in Korea was 22.6 in 2018, much higher compared to other countries worldwide. As mental and psychiatric problems are the main reasons for suicide attempts, accounting for 31.6% in 2018, targeting such problems should be the focus of efforts to reduce suicide rates. However, the ability of current pharmacotherapeutic and psychotherapeutic interventions to reduce suicide rates is limited due to their delayed effects. Therefore, electroconvulsive therapy (ECT) has been proposed as an alternative treatment. This approach is effective for treating most mental disorders associated with high suicide rates, including severe depression, bipolar disorder, and intractable psychotic disorders; ECT is also effective for Parkinson's disease, which has the highest suicide rate among all disorders in Korea. The acute, long-term, and prophylactic effects of ECT on suicidality have been reported in the literature, and treatment guidelines outside of Korea recommend that ECT be used at an early stage for rapid reduction of suicide rates, as opposed to being applied as a treatment of last resort. However, only ~0.092 of every 10000 members of the Korean general population received ECT in 2018; this is much lower than the average rate worldwide, of 2.2 per 10000. Elimination of obstacles to the use of ECT, early crisis intervention involving administration of ECT for rapid stabilization, and maintenance ECT to prevent recurrence should reduce suicide rates.
Keywords
Mental health; Crisis intervention; Suicidality; Electroconvulsive therapy;
Citations & Related Records
Times Cited By KSCI : 6  (Citation Analysis)
연도 인용수 순위
1 Meyer RE, Salzman C, Youngstrom EA, Clayton PJ, Goodwin FK, Mann JJ, et al. Suicidality and risk of suicide--definition, drug safety concerns, and a necessary target for drug development: a brief report. J Clin Psychiatry 2010;71:1040-1046.   DOI
2 Gibbons RD, Brown CH, Hur K, Davis J, Mann JJ. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012;69:580-587.   DOI
3 Reinstatler L, Youssef NA. Ketamine as a potential treatment for suicidal ideation: a systematic review of the literature. Drugs R D 2015;15:37-43.   DOI
4 Wilkinson ST, Sanacora G. Ketamine: a potential rapid-acting antisuicidal agent? Depress Anxiety 2016;33:711-717.   DOI
5 Oji C, Moore TA, Gutierrez CA. A review of electroconvulsive therapy in suicidality. Ment Health Clin 2015;5:212-215.   DOI
6 Payne NA, Prudic J. Electroconvulsive therapy: Part I. A perspective on the evolution and current practice of ECT. J Psychiatr Pract 2009;15:346-368.   DOI
7 Kang UG, Kim SH, Kim YS. Mechanism of action. In: Kim YS, Chung IW, Kang UG, Ahn YM, Youn T, editors. Electroconvulsive Therapy: Theory and Practice. Seoul: Seoul National University Press;2019. p.33-62.
8 Weiss A. The Electroconvulsive Therapy Workbook: Clinical Applications. New York, NY: Routledge;2018.
9 Ministry of Health and Welfare, Health Insurance Review & Assessment Service. Production and Development of OECD Health Care Quality Indicators in 2014. Sejong: Ministry of Health and Welfare;2016.
10 Lee S, Chae S, Jung J, Yun S, Cha M. Reinforcing the Care Programs for the Suicide Attempters in Korea. Korea Institute for Health and Social Affairs;2017.
11 Organisation for Economic Co-operation and Development. Suicide rates (indicator). Available from: https://data.oecd.org/healthstat/suicide-rates.htm.
12 Dombrovski AY, Mulsant BH. ECT: the preferred treatment for severe depression in late life. ECT: the preferred treatment for severe depression in late life. Int Psychogeriatr 2007;19:10-14.   DOI
13 Maixner DF. ECT in the United States. Proceedings of the 29th Annual Meeting & ECT Certificate Course; 2019 May 18-19, San Francisco, CA, USA.
14 Grover S, Garekar H, Agarwal A. Treatment-resistant schizophrenia: assessment and management. Kim YK, editor. In: Treatment Resistance in Psychiatry: Risk Factors, Biology, and Management. Singapore: Springer;2019. p.109-137.
15 Korean Statistical Information Service. Korea health statistics: cause of death. Daejeon: Statistics Korea [cited 2018 Dec 14]. Available from: http://kosis.kr/statisticsList/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ZTITLE&parmTabId=M_01_01#SelectStatsBoxDiv.
16 Leiknes KA, Jarosh-von Schweder L, Hoie B. Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav 2012;2:283-344.   DOI
17 Chung IW, Kim HC, Jeong SH. Development in Korean Guideline of Electroconvulsive Therapy as a Service for Crisis Intervention in Mental Health. National Center for Mental Health; Korea Mental Health R&D Project;2019.
18 Youssef NA, Ravilla D, Patel C, Yassa M, Sadek R, Zhang LF, et al. Magnitude of reduction and speed of remission of suicidality for low amplitude seizure therapy (LAP-ST) compared to standard right unilateral electroconvulsive therapy: a pilot double-blinded randomized clinical trial. Brain Sci 2019;9:99.   DOI
19 Large MM. The role of prediction in suicide prevention. Dialogues Clin Neurosci 2018;20:197-205.   DOI
20 Irigoyen M, Porras-Segovia A, Galvan L, Puigdevall M, Giner L, De Leon S, et al. Predictors of re-attempt in a cohort of suicide attempters: a survival analysis. J Affect Disord 2019;247:20-28.   DOI
21 Working Committee for Algorithm Revision on Korean Schizophrenia Pharmacotherapy. Korean Schizophrenia Pharmacotherapy Guideline. Korean College of Neuropsychopharmacology; Korean Society of Schizophrenia Research;2019.
22 Kim SW, Jhon M, Kim M, Paik JW, Kim JM, Yoon JS. A social psychiatric approach to suicide prevention. J Korean Med Assoc 2019;62:93-101.   DOI
23 Korea Suicide Prevention Center. 2018 Statistics Data. Seoul: Korea Suicide Prevention Center;2019.
24 Ryan CJ, Large MM. Suicide risk assessment: where are we now? Med J Aust 2013;198:462-463.   DOI
25 Ministry of Health and Welfare, Korea Suicide Prevention Center. 2019 White Book of Suicide Prevention. Seoul: Korea Suicide Prevention Center;2019.
26 Statistics Korea. Causes of Death Statistics in 2018. Daejeon: Statistics Korea;2019.
27 Kellner CH. ECT treatment course. In: Handbook of ECT: A Guide to Electroconvulsive Therapy for Practitioners. New York, NY: Cambridge University Press;2019. p.153-166.
28 Cormack S, Chan P, Persaud R, Vila-Rodriguez F. Index electroconvulsive therapy course to treat severe suicidality and depression in fahr disease. J ECT 2016;32:72-73.   DOI
29 Foster TJ. Suicide prevention as a prerequisite for recovery from severe mental illness. Int J Psychiatry Med 2013;46:15-25.   DOI
30 Ionescu DF, Bentley KH, Eikermann M, Taylor N, Akeju O, Swee MB, et al. Repeat-dose ketamine augmentation for treatment-resistant depression with chronic suicidal ideation: a randomized, double blind, placebo controlled trial. J Affect Disord 2019;243:516-524.   DOI
31 Flood RA, Seager CP. A retrospective examination of psychiatric case records of patients who subsequently committed suicide. Br J Psychiatry 1968;114:443-450.   DOI
32 Kellner CH, Fink M, Knapp R, Petrides G, Husain M, Rummans T, et al. Relief of expressed suicidal intent by ECT: a consortium for research in ECT study. Am J Psychiatry 2005;162:977-982.   DOI
33 Statistics Canada; Canadian Institute for Health Information. Health Indicators 2011. Ottawa: Canadian Institute for Health Information;2011.
34 Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, et al. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015;29:459-525.   DOI
35 Babigian HM, Guttmacher LB. Epidemiologic considerations in electroconvulsive therapy. Arch Gen Psychiatry 1984;41:246-253.   DOI
36 Isometsa ET, Henriksson MM, Heikkinen ME, Lonnqvist JK. Completed suicide and recent electroconvulsive therapy in Finland. Convuls Ther 1996;12:152-155.
37 Tsuang MT, Dempsey GM, Fleming JA. Can ECT prevent premature death and suicide in 'schizoaffective' patients? J Affect Disord 1979;1:167-171.   DOI
38 Liang CS, Chung CH, Ho PS, Tsai CK, Chien WC. Superior antisuicidal effects of electroconvulsive therapy in unipolar disorder and bipolar depression. Bipolar Disord 2018;20:539-546.   DOI
39 Black DW, Winokur G, Nasrallah A, Emmanuel M, Woolson R. Does treatment influence mortality in depressives? [abstract]. Proceedings of The 141st Annual Meeting of the American Psychiatric Association;1988 May 7-12, Montral, Quebec, Canada.
40 Dubovsky SL, Dubovsky AN. Mood disorders and the outcome of suicidal thoughts and attempts. Crit Care Clin 2008;24:857-874.   DOI
41 Mutschler C, Lichtenstein S, Kidd SA, Davidson L. Transition experiences following psychiatric hospitalization: a systematic review of the literature. Community Ment Health J 2019;55:1255-1274.   DOI
42 Taylor MA, Fink M. Melancholia: The Diagnosis, Pathophysiology, and Treatment of Depressive Disorders. Cambridge: Cambridge University Press;2006.
43 Korea Psychological Autopsy Center. Psychological Autopsy Analysis Result Data [cited 2020 Feb 21]. Available from: http://www.psyauto.or.kr/sub/data_02.asp.
44 Lee AS, Murray RM. The long-term outcome of Maudsley depressives. Br J Psychiatry 1988;153:741-751.   DOI
45 Jamison KR, Baldessarini RJ. Effects of medical interventions on suicidal behavior. Introduction. J Clin Psychiatry 1999;60 Suppl 2:4-6; discussion 113-6.
46 Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ 2009;180:291-297.   DOI
47 Spielmans GI, Jureidini J, Healy D, Purssey R. Inappropriate data and measures lead to questionable conclusions. JAMA Psychiatry 2013;70:121-122.
48 Hermann RC, Dorwart RA, Hoover CW, Brody J. Variation in ECT use in the United States. Am J Psychiatry 1995;152:869-875.   DOI
49 Gwun OJ, Park GJ, Kim SC, Lee JH, Kim H, Lee SW. Impact of discharge against medical advice on emergency department revisit among suicide attempters. J Korean Soc Emerg Med 2019;30:393-400.
50 Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, et al. Electroconvulsive therapy augmentation in clozapineresistant schizophrenia: a prospective, randomized study. Am J Psychiatry 2015;172:52-58.   DOI
51 Kellner CH, Patel SB. The role of ECT in the suicide epidemic. Psychiatr Times 2018;35:8.
52 Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013;15:1-44.
53 Bradvik L, Berglund M. Long-term treatment and suicidal behavior in severe depression: ECT and antidepressant pharmacotherapy may have different effects on the occurrence and seriousness of suicide attempts. Depress Anxiety 2006;23:34-41.   DOI
54 Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. Am J Psychiatry 2000;157:1-45.   DOI
55 National Institute for Health and Clinical Excellence. Guidance on the Use of Electroconvulsive Therapy (Technology Appraisal Guidance TA59). London: National Institute for Health and Clinical Excellence;2003.
56 Prudic J, Sackeim HA. Electroconvulsive therapy and suicide risk. J Clin Psychiatry 1999;60 Suppl 2:104-110; discussion 111-6.
57 Joo SW, Jeong HE, Chon MW, Joo YH, Kim CY, Lee JS. Effectiveness and safety of electroconvulsive therapy in clinical practice. J Korean Neuropsychiatr Assoc 2016;55:202-208.   DOI
58 Aksoy-Poyraz C, Ozdemir A, Ozmen M, Arikan K, Ozkara C. Electroconvulsive therapy for bipolar depressive and mixed episode with high suicide risk after epilepsy surgery. Epilepsy Behav 2008;13:707-709.   DOI
59 Tavares AR, Volpe FM. Electroconvulsive therapy (ECT) effective for psychotic recrudescence and suicidality after varenicline adjunctive therapy for smoking cessation in a schizoaffective patient. Braz J Psychiatry 2010;32:315-316.   DOI
60 Munk-Olsen T, Laursen TM, Videbech P, Mortensen PB, Rosenberg R. All-cause mortality among recipients of electroconvulsive therapy: register-based cohort study. Br J Psychiatry 2007;190:435-439.   DOI
61 Hunt IM, Windfuhr K, Swinson N, Shaw J, Appleby L, Kapur N, et al. Electroconvulsive therapy and suicide among the mentally ill in England: a national clinical survey. Psychiatry Res 2011;187:145-149.   DOI
62 Thomas SG, Kellner CH. Remission of major depression and obsessive-compulsive disorder after a single unilateral ECT. J ECT 2003;19:50-51.   DOI
63 Health Insurance Review & Assessment Service; National Health Insurance Service. 2018 National Health Insurance Statistical Yearbook. Wonju: Health Insurance Review & Assessment Service; National Health Insurance Service;2019.
64 Chang SS. The role of ECT in suicide management. Taiwanese J Psychiatry 2007;21:4-15.
65 Walter F, Carr MJ, Mok PLH, Antonsen S, Pedersen CB, Appleby L, et al. Multiple adverse outcomes following first discharge from inpatient psychiatric care: a national cohort study. Lancet Psychiatry 2019;6:582-589.   DOI
66 Lin CH, Yang WC, Wu JI. Factors affecting time to resolution of suicidality for depressed patients receiving electroconvulsive therapy. CNS Spectr 2020;25:434-435.   DOI
67 Kuo CJ, Tsai SY, Liao YT, Lee WC, Sung XW, Chen CC. Psychiatric discharge against medical advice is a risk factor for suicide but not for other causes of death. J Clin Psychiatry 2010;71:808-809.   DOI
68 Kim H, Kim JW, Kang HJ, Kim SY, Lee JY, Kim JM, et al. Factors associated with suicidal behavior of psychiatric inpatients. J Korean Neuropsychiatr Assoc 2019;58:202-208.   DOI
69 Andrews M, Hasking P. Effect of two educational interventions on knowledge and attitudes towards electroconvulsive therapy. J ECT 2004;20:230-236.   DOI
70 Dowman J, Patel A, Rajput K. Electroconvulsive therapy: attitudes and misconceptions. J ECT 2005;21:84-87.   DOI
71 The Assessment and Management of Risk for Suicide Working Group. VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide. Version 1.0. Washington, DC: Veterans Health Administration; Department of Defense;2013.
72 National Collaborating Centre for Mental Health (UK). Depression: the treatment and management of depression in adults (updated edition). Leicester: British Psychological Society;2010.
73 Rapinesi C, Serata D, Del Casale A, Simonetti A, Milioni M, Mazzarini L, et al. Successful and rapid response to electroconvulsive therapy of a suicidal patient with comorbid bipolar I disorder and histrionic personality disorder. J ECT 2012;28:57-58.   DOI
74 Chung DT, Ryan CJ, Hadzi-Pavlovic D, Singh SP, Stanton C, Large MM. Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA Psychiatry 2017;74:694-702.   DOI
75 Avery D, Winokur G. Suicide, attempted suicide, and relapse rates in depression. Arch Gen Psychiatry 1978;35:749-753.   DOI
76 Samalin L, Yrondi A, Charpeaud T, Genty JB, Blanc O, Sauvaget A, et al. Adherence to treatment guidelines in clinical practice for using electroconvulsive therapy in major depressive episode. J Affect Disord 2020;264:318-323.   DOI
77 Gambill JD, McLean PE. Suicide after unilateral ECT in a patient previously responsive to bilateral ECT. Psychiatr Q 1983;55:279-281.   DOI
78 Kobeissi J, Aloysi A, Tobias K, Popeo D, Kellner CH. Resolution of severe suicidality with a single electroconvulsive therapy. J ECT 2011;27:86-88.   DOI
79 Fligelman B, Pham T, Bryson EO, Majeske M, Kellner CH. Resolution of acute suicidality after a single right unilateral electroconvulsive therapy. J ECT 2016;32:71-72.   DOI
80 American Psychiatric Association. Practice Guidelines for the Treatment of Patients with Schizophrenia. 3rd ed. Washington, DC: American Psychiatric Association;2010.
81 American Psychiatric Association, Committee on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging: A task force report of the American Psychiatric Association (2nd ed). Washington, DC: American Psychiatric Association;2001.
82 Patel M, Patel S, Hardy DW, Benzies BJ, Tare V. Should electroconvulsive therapy be an early consideration for suicidal patients? J ECT 2006;22:113-115.   DOI
83 Kellner CH, Husain MM, Knapp RG, McCall WV, Petrides G, Rudorfer MV, et al. A novel strategy for continuation ECT in geriatric depression: phase 2 of the PRIDE study. Am J Psychiatry 2016;173:1110-1118.   DOI
84 Tran DV, Meyer JP, Farber KG, Chen XR, Rosenthal BD, Kellner CH. Rapid response to electroconvulsive therapy: a case report and literature review. J ECT 2017;33:e20-e21.
85 Kellner CH, Knapp RG, Petrides G, Rummans TA, Husain MM, Rasmussen K, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry 2006;63:1337-1344.
86 Fink M, Kellner CH, McCall WV. The role of ECT in suicide prevention. J ECT 2014;30:5-9.   DOI
87 Kellner CH, Li EH, Farber KG, Geduldig ET, Ahle GM. Electroconvulsive therapy (ECT) and suicide prevention. Curr Treat Options Psychiatry 2016;3:73-81.   DOI
88 Sienaert P. What we have learned about electroconvulsive therapy and its relevance for the practising psychiatrist. Can J Psychiatry 2011;56:5-12.   DOI
89 Yoon JS, Kim CY, Ahn JH. Critique of mental health welfare law in Korea : focusing on involuntary hospitalization criteria. J Korean Neuropsychiatr Assoc 2018;57:145-156.   DOI
90 Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006;163:1905-1917.   DOI
91 Gusmao R, Quintao S, McDaid D, Arensman E, Van Audenhove C, Coffey C, et al. Antidepressant utilization and suicide in europe: an ecological multi-national study. PLoS One 2013;8:e66455.   DOI
92 Kim B, Lee J, Kim E, Kim SH, Ha K, Kim YS, et al. Sex difference in risk period for completed suicide following prior attempts: Korea National Suicide Survey (KNSS). J Affect Disord 2018;227:861-868.   DOI
93 Rich CL, Spiker DG, Jewell SW, Neil JF. Response of energy and suicidal ideation to ECT. J Clin Psychiatry 1986;47:31-32.
94 Ballard ED, Zarate CA Jr. Preventing suicide: a multicausal model requires multimodal research and intervention. Bipolar Disord 2018;20:558-559.   DOI
95 Kim SJ. Pharmacological treatment strategies for acute bipolar depression. J Korean Neuropsychiatr Assoc 2018;57:287-300.   DOI
96 Woo YS, Bahk WM, Lee JG, Jeong JH, Kim MD, Sohn I, et al. Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018): Fourth Revision. Clin Psychopharmacol Neurosci 2018;16:434-448.   DOI
97 Korea Suicide Prevention Center, Emergency Room Support Team. Analysis of demographic characteristics and follow-up service results of suicide attempters - focusing on institutes of 2017 emergency room-based suicide attempter aftercare programs. KSPC Res Brief 2018:(2):1-12.
98 Kim W, Bahk WM, Yoon BH, Jon DI, Seo JS, Lee JG, et al. Korean medication algorithm for bipolar disorder 2018: overview. Mood Emot 2018;16:1-12.
99 Man JJ, Currier D. Suicide and attempted suicide. In: Fatemi SH, Clayton PJ, editors. The Medical Basis of Psychiatry (4th ed). New York, NY: Springer;2016. p.687-706.
100 Nah G, Choi S, Kim H, Lee JY, Kim JM, Shin IS, et al. Characteristics of patients who died by suicide in a community mental health center. Korean J Schizophr Res 2017;20:55-60.   DOI
101 Jeong SH, Youn T, Kim YS. Social implication. In: Kim YS, Chung IW, Kang UG, Ahn YM, Youn T, editors. Electroconvulsive Therapy: Theory and Practice. Seoul: Seoul National University Press; 2019. p.33-62.
102 American Psychiatric Association. Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry 2003;160(11 Suppl):1-60.   DOI
103 Choi M, Kim H, Qian H, Palepu A. Readmission rates of patients discharged against medical advice: a matched cohort study. PLoS One 2011;6:e24459.   DOI
104 Health Insurance Review & Assessment Service; National Health Insurance Service. 2018 Medical Aid Statistics. Wonju: Health Insurance Review & Assessment Service; National Health Insurance Service;2019.
105 Lam RW, Kennedy SH, Grigoriadis S, McIntyre RS, Milev R, Ramasubbu R, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. J Affect Disord 2009;117 Suppl 1:S26-S43.   DOI
106 Arato M, Demeter E, Rihmer Z, Somogyi E. Retrospective psychiatric assessment of 200 suicides in Budapest. Acta Psychiatr Scand 1988;77:454-456.   DOI
107 Kim HJ, Lee IH. Visual analysis of regional variations in antidepressant use and suicide rate. Korean J Clin Pharm 2018;28:308-319.   DOI
108 Youn T, Kang UG, Kim YS, Chung IW. Recent trends for optimization of electroconvulsive therapy. J Korean Neuropsychiatr Assoc 2016;55:12-24.   DOI
109 Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med 2003;33:395-405.   DOI