Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis
The LancetPublished 1 March 2003
Citations1,635
SJR quartileQ1
SJR score12.11
SNIP22.72
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TL;DR
A systematic overview and meta-analysis of randomised controlled trials and observational studies for the efficacy and safety of electroconvulsive therapy with simulated ECT, ECT versus pharmacotherapy, and different forms of ECT for patients with depressive illness found ECT is an effective short-term treatment for depression.
Abstract
ECT is an effective short-term treatment for depression, and is probably more effective than drug therapy. Bilateral ECT is moderately more effective than unilateral ECT, and high dose ECT is more effective than low dose.
Keywords
Medicine
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