Past Issues

Objective: This study reviewed the literature regarding the acute and longterm
effects of ECT on suicide risk to examine the role of ECT in the management
and prevention of suicide. Methods: A Medline search was undertaken with key
words "Electroconvulsive therapy ( ECT )" combined with "suicide" up to June
2006. From the references of these reports, additional articles were collected.
Results: Review of recent two reports on acute effect of ECT on suicidality, shows
that the benefits of ECT are marked and immediate. The long-term effect of ECT
on suicidal risk has not been consistently or uniformly shown in the literature.
However, there are some evidences of a positive effect in nearly half of the 20 studies
reviewed. The reports also showed the effect of ECT in reduction in the overall
mortality during the follow up. The finding that the decrease in suicide risk during
ECT might not necessarily be proportional to the improvement in clinical depressive
symptoms, raised the possibility of "suicidal syndrome". Whether the "
suicidal syndrome" exists independently of depression or other psychiatric diagnosis
deserved further exploration. Conclusion: ECT plays an important role in
the management and prevention of suicide. Considering the rapid relief of suicide
risk by ECT and the delayed onset of action of medications, in severe depressed
patients, it should be considered earlier than at its conventional "last resort" position
especially in patient with suicide risk.