Chittaranjan Andrade
Electroconvulsive therapy (ECT) is associated with early benefits and with high response and remission rates in patients with depression; recovery from depression may, in turn, carry short- and long-term benefits. This article examines observational data on short- and long-term all-cause mortality, nonsuicide mortality, and suicide mortality following treatment of depression with ECT. To frame the subject in its proper context, a very large meta-analysis found that, relative to nondepressed or general population controls, depression was associated with a doubled risk of all-cause mortality, a tenfold risk of suicide mortality, and an increased risk of mortality in the presence of a wide range of medical comorbidities. All-cause mortality risks were also higher in psychotic depression relative to nonpsychotic depression and in treatment-resistant depression relative to depression that was not treatment-resistant. Three meta-analyses on mortality risks following ECT were published in 2025; these had partially, but not fully, overlapping datasets. The overall impression from these meta-analyses was that ECT-treated depressed cohorts were at lower risk of all-cause mortality, nonsuicide mortality, and natural cause mortality relative to comparison cohorts receiving treatments other than ECT. The all-cause mortality benefit was evident early as well as during long-term follow up. ECT-treated cohorts were also at lower risk of suicide mortality, though this finding appeared to be limited to the initial months posttreatment. Possible explanations for the findings are considered. Confounding by indication and confounding by severity of indication may also play a role, though more against ECT than in favor of ECT. Although cause-effect relationships cannot be asserted from observational studies, these findings encourage the use of ECT in depressed subjects for whom ECT is indicated. However, these findings cannot be extrapolated to all depressed samples.