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Jan. 13 (Bloomberg) — People suffering from moderate and severe depression are best treated with antidepressants and electroshock therapy regardless of public and professional misgivings, according to a review in tomorrow’s Lancet.

Drugs remain the mainstay of depression therapy and electroshock is still the most effective treatment, particularly with patients who have psychotic symptoms such as delusions and hallucinations, said Klaus Ebmeier, a psychiatrist and professor at the University of Edinburgh who reviewed the condition over the past five years.

The perfect treatment for depression “would be effective in a large portion of patients, its action would be limited to the brain and not interfere with other body functions, it would be non-invasive and it would have a minimum of side effects,'’ Ebmeier said in an e-mailed exchange. “In addition it would be effective in treating depression and preventing recurrence.'’

Concern about the safety and effectiveness of electroshock therapy and reports claiming antidepressants cause patients to commit suicide or become addicted may have disconcerted the public and members of the medical profession, Ebmeier said. Depression affects as many as 40 million people, or one in six at one point in their lives, in the U.S. and is under-diagnosed.

“For many people a diagnosis of depression is made worse by the social stigma that still clings to all mental-health diagnoses, by difficulties in accessing treatment options, and by confusion about which treatments work and which may make their problems worse,'’ the Lancet comments in an editorial.

Electrodes on the Head

Antidepressants are the best choice for most patients because of their effectiveness and availability, while psychotherapy is recommended for milder depression or added to antidepressants in more severe illness. Other treatments may be considered when the first one prescribed doesn’t work, as is the case in 20 percent to 40 percent of patients, Ebmeier said.

Producing epileptic seizures in depressive patients was more effective than drug therapy in reducing symptoms of depression, according to an analysis of 18 clinical trials by researchers from the University of Oxford.

Electroshock therapy has been used as a treatment for mental disorders since the 1930s. Publications including Ken Kesey’s 1962 book, “One Flew Over the Cuckoo’s Nest,'’ about a U.S. mental hospital raised concern about the therapy, in which doctors place electrodes on the head and send electrical current through the brain of the patient to trigger a grand mal seizure.

To contact the reporter on this story:
Chantal Britt in Stockholm at cbritt@bloomberg.net.

Last Updated: January 13, 2006 08:09 EST