Electroconvulsive Therapy Use in Major Depressive Disorder Hospitalizations in Portugal

Introduction: 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. 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 Modification (ICD­ ‑9­ ‑CM) codes 296.2x to 296.3x (Major depressive disorder), 300.4 (Dysthymic disorder) and 311 (Depressive disorder, not elsewhere classified) 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%), with only 2.8% of depression hospitalizations having received ECT in the last year. 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 demonstrate an underuse of ECT procedures in depression hospitalizations in Portugal. The observed increase in ECT utilization in the study period 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.