Electroconvulsive therapy use in major depressive disorder related hospitalizations in Portugal

Abstract

Background: Depression, recognized as a major contributor to global disability, requires diverse therapeutic strategies. While psychological therapy and antidepressant medications are primary interventions, Electroconvulsive Therapy (ECT) emerges as a valuable option for severe and treatment-resistant cases. Objectives: This retrospective observational study explores the scenery of depressive disorder-related hospitalizations in Portuguese public hospitals from 2008 to 2015. Methods: Utilizing administrative data provided by Administração Central do Sistema de Saúde I.P. (ACSS), hospitalizations with primary depression diagnoses were examined. Therefore, all hospitalizations from patients aged 18 or older with a primary diagnosis of depression, selected by International Classification of Diseases, Ninth Revision, Clinical Modifcation (ICD-9-CM) codes 296.2x to 296.3x (Major depressive disorder), 300.4 (Dysthymic disorder) and 311 (Depressive disorder, not elsewhere classifed) were included. Results: Over the study period, 32,648 hospitalizations with primary depression diagnoses were identified. Major Depressive Disorder recurrent episodes dominated ECT procedures (72.6%). A linear increase in ECT cases from 2010 to 2015 was observed, coinciding with a decline in total depressive disorder-related hospitalizations. A higher proportion of men received ECT compared to women. The mean age of ECT recipients was significantly lower. Discussion: The study's findings align with international trends, showcasing ECT as a valuable intervention for Major Depressive Disorder, especially in severe and treatment-resistant cases. The observed increase in ECT utilization may indicate evolving perceptions and improved accessibility. Conclusion: Depressive disorders constitute a significant portion of psychiatric hospitalizations in Portugal. This study contributes to understanding ECT use in Portugal.