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Ask the Experts

Question:

Can someone with treatment refractory depression who also has a mild learning disability try ect or could it make the learning disability worse?

Answered by: Sarah Lisanby

Electroconvulsive therapy (ECT) is an effective treatment for severe major depression. ECT is often used when medications and psychotherapy are not fully effective, or when the side effects of medications are not tolerable.

Like any medical treatment, ECT has a risk of side effects. These side effects should be weighed against the likely benefits of ECT, and also against the likelihood that alternative treatments, such as medications or psychotherapy, would be effective. One of the side effects of ECT is memory loss. It is always important to discuss these risks and benefits, and treatment alternatives, with your doctor to help make an informed decision about ECT.

Persons with learning disability or mental retardation can experience major depression. Sometimes the depression does not respond to medications or psychotherapy. In such cases, ECT may be considered. In thinking about whether ECT is right for someone with a learning disability or mental retardation, it is important to consider whether the person has a diagnosis that is likely to respond to ECT (such as depression), whether the person is at increased risk for side effects from ECT, and whether the person is able to give informed consent for the treatment.

The safety and efficacy of ECT in persons with learning disability or mental retardation has not been systematically studied. However, there are several published literature reviews and case studies on this topic. These reports generally support the view that ECT shows similar efficacy and safety in persons with depression who have mental retardation as it does in persons without mental retardation. These case reports and literature reviews also suggest that ECT did not appear to worsen intellectual functioning in these patients, however it should be noted that there have not been systematic studies using extensive testing of intellectual functioning before and after ECT in this population. These studies also suggest that the use of ECT is typically delayed in persons with learning disability or mental retardation. Delay in treatment may result in worsening of the depression.

In summary, the limited available evidence suggests that ECT has a similar risk/benefit ratio when used in persons with learning disability or mental retardation. Further research on the safety and efficacy of ECT in this population would be very useful.

For further information:

Aziz M, Maixner DF, DeQuardo J, Aldridge A, Tandon R. ECT and mental retardation: a review and case reports. J ECT. 2001 Jun;17(2):149-52.

Kessler RJ. Electroconvulsive therapy for affective disorders in persons with mental retardation. Psychiatr Q. 2004 Spring;75(1):99-104.

Little JD, McFarlane J, Ducharme HM. ECT use delayed in the presence of comorbid mental retardation: a review of clinical and ethical issues. J ECT. 2002 Dec;18(4):218-22.

Reinblatt SP, Rifkin A, Freeman J. The efficacy of ECT in adults with mental retardation experiencing psychiatric disorders. J ECT. 2004 Dec;20(4):208-12.