Subjective symptoms in depression and during the course of electroconvulsive therapy

Subjective symptoms were assessed 1 hour and 50 minutes after each of 8 ECT treatments in a series of 12. By this time all patients were fully oriented and had completed cognitive assessment. A subgroup of patients was also assessed after simulated ECT. Additional assessments of subjective symptoms were done during the pre-ECT depressive state and 3 days after completion of the ECT series. The results showed a decrease in acute subjective symptoms as a function of the number of real ECT treatments in the series. These acute-subjective symptoms were greater after real ECT than after simulated ECT. A decrease in the number of symptoms reported before ECT was noted 3 days after the completion of the ECT series. The severity of depression, as measured by the Hamilton Depression Scale, was correlated with the magnitude of acute subjective symptoms only in the two later assessments in the series. It is suggested that the effect of the ECT is paradoxical. It causes an increase in the severity of symptoms experienced acutely after each treatment but reduces the severity of symptoms experienced acutely at later treatments.