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Dear Sir

I am prompted to write by Michael Dennis’ article on suicide in old age, because
ECT was not mentioned.¹ There
are high rates of depressive illness among
elderly people attempting suicide and often
these are quite severe. My guidance to trainees
assessing such patients is that there should
be a very good reason for not transferring
them for a period of inpatient care to ensure
effective treatment of any depressive component.
If recovery is not achieved with medication
(and often there has already been a reasonable
trial of antidepressants) I would proceed
to ECT. I have found that augmentation with
thyroid hormones and lithium seldom achieve
full remission in really severe cases of
depression. I do use lithium to prevent
recurrence of more biological depressions.
Though this approach may not be derived
from evidence based medicine, most trial
evidence on antidepressants focuses on symptom
improvement rather than full recovery. At
least there is good evidence for the use
of ECT in older people.²

References

1. Denniss M S. Suicide in Old Age. CPD
Bulletin Old Age Psychiarty 1998; 1:
3-5.

2. Wilkinson D, Daoud J. 1998 The stigma
and enigma of ECT.

International Journal of Geriatric
Psychiatry 13: 833-35.