ECT Reduces Suicidality and Mortality in Refractory Depression
Can ECT Save Lives by Reducing Suicide Risk in Severe Depression?
Yes. Electroconvulsive therapy (ECT) significantly reduces suicidality and all-cause mortality in refractory depression, with a 34% decrease in suicide risk and a 30% reduction in all-cause mortality. A systematic review and meta-analysis of 26 studies published in Neuroscience Applied shows ECT provides substantial life-saving protection for patients with severe, treatment-resistant depression.
What the data show:
- Suicide reduction: 34% decrease in suicide risk, with 1.70% suicide deaths in ECT group vs 5.02% in controls
- All-cause mortality: 30% reduction in overall mortality, with 3.13% deaths in ECT group vs 6.64% in controls
- Suicidal ideation: Significant reduction in suicidal thoughts and ideation
- Target population: Particularly effective in patients with most severe, treatment-resistant depression — the population at highest risk for suicide
- Rapid onset: ECT can begin reducing suicidal ideation within days, making it valuable for urgent suicide prevention
- VNS benefit: Vagus nerve stimulation also shows 60% reduction in all-cause mortality
- Mechanism: ECT works by rapidly reversing severe physiological and psychological consequences of refractory depression through electrical stimulation that triggers widespread neurochemical changes, enhances neuroplasticity, and normalizes brain circuit function — this rapid and robust response explains why ECT can provide life-saving protection within days rather than weeks, making it crucial for preventing suicide in acutely dangerous situations
A systematic review and meta-analysis published in Neuroscience Applied demonstrates that electroconvulsive therapy reduces suicidality and all-cause mortality in refractory depression. Depressive disorders are among the most common psychiatric disorders worldwide and are associated with half of all suicides. There is robust evidence indicating that both electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) effectively alleviate depressive symptoms in difficult-to-treat depression and enhance patient outcomes. However, there has been ongoing debate regarding their potential roles in preventing suicide and reducing all-cause mortality.