{br} STUCK with your assignment? {br} When is it due? {br} Get FREE assistance. Page Title: {title}{br} Page URL: {url}
UK: +44 748 007-0908, USA: +1 917 810-5386 [email protected]

    Select a mental disorder, population-focused issue, or treatment strategy for in-depth study based of evidence and best practices. Be sure to get your paper topic approved by course faculty or clinical instructor. A specific treatment option can be selected as a topic and the paper criteria will be modified accordingly. Paper topics can be selected for patients not seen on clinical units where you are placed. Topics can be selected to represent the wide range of the mental health practice area. (8-10 pages including cover page and references).


Subject Psychology Pages 5 Style APA


Efficacy and Safety of Electroconvulsive Therapy in Depressed Older Adults

This paper focuses on the efficacy of electroconvulsive therapy (ECT) in treatment depression among the elderly patient population. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes depression, otherwise known as clinical depression or a major depressive disorder, as a serious and common mood disorder. A person should be manifesting with at least five or more symptoms presented in the DSM-5 criteria for depression for a period not less than 14 days. Symptoms presented in the DSM-5 criteria for depression include loss of pleasure or interest, depressed mood, significant weight loss or weight gain and/or decrease or increase in appetite, reduced physical movement or thought processes observed by others, loss of energy or fatigue, worthlessness feelings or inappropriate guilt, diminished ability to concentrate or think, and/or recurrent thoughts of suicidal ideation or death (American Psychiatric Association, 2013).  Depression in DSM-5 is classified under depressive disorders include other new conditions such as hopelessness (Uher et al., 2014). The U.S. Department of Health and Human Services (2018) affirms that depression is not considered as a normal part of aging. To reduce risk of polypharmacy among elderly patients with other conditions apart from depression, ECT is hereby presented as an alternative non-pharmacological treatment mode for depression.

Background Information

            Depression is one of the common psychiatric disorders. It affects approximately 350 million globally. In addition, about 800,000 people commit suicide due to depression per year around the world (Moledina, Bhimji, & Manji, 2018). Estimated lifetime prevalence rate of depression is 10% among the general population, whereas the prevalence can be more the 20% in clinical settings (Uher et al., 2014).  Depression is more common among people aged above 44 years (39.3%) of age. Comparatively, depression prevalence in other age groups is at 26% for people aged below 25 years of age, 19% for people who fall between 25 and 34 years, and 15.6% for people who are aged 35 to 44 years. Depression tends to become more prevalent with age (Moledina, Bhimji, & Manji, 2018). Since depression is more common among the elderly, effective and safe strategies should be employed. One of such treatment strategies is ECT (Kerner & Prudic, 2014). Among the elderly patients, depression is linked with increased mortality and morbidity. Besides, it is an independent cause of disability (Padayacchey, Ramlall & Chipps, 2017). Early detection and effective treatment of depression among elderly patients is highly recommended.

Beck’s Theory of Depression with Focus on ECT

            Beck’s theory is one of the middle-range theories. Beck’s theory of depression states that depressed individuals tend to appraise events in a negative manner. In this theory, three mechanisms are thought to be responsible for development of depression. The first mechanism is referred to as the cognitive triad, otherwise referred to as negative automatic thinking. The second mechanism is self-schemas, whereas the third and the last mechanism is errors in logic. Errors in logic entail faulty processing of information (Mollard, 2014). Basing on this theory, ECT is thought to help correct errors in information processing. In this theory, depression is not considered as a product of environmental or social conditions but a medical condition and a personal pathological disorder (Abdollahi, Lye, & Zarghami, 2016).

Basing on the theoretical foundations of Beck’s theory, ECT has emerged as one of the effective non-pharmacological interventions for management of depression.  With reference to Beck’s theory, late-life onset of depression is frequently associated with organic causes that can be effectively managed with ECT. Research has shown that ECT is the most rapid and effective treatment modality for managing elderly patients who present with depression, psychosis, and bipolar disorder. On the other hand, the therapy is life saving for elderly patients who suffer from neuroleptic malignant syndrome and catatonia. ECT is thought to result into normalization of endocrine dysfunction; especially in the case of melancholic depression (Kerner & Prudic, 2014).

ECT is beneficial, especially for elderly patients who cannot tolerate mediations. Besides, it is useful for management of depression cases that seem to respond poorly upon treatment with medications. On the other hand, ECT is fit for use in patients who stand at a high-risk of experiencing toxic drug interactions or drug-induced toxicity. As such, ECT is one of the safest treatment options for depressed adult patients (Kerner & Prudic, 2014).

Other Current Treatment Strategies


            Depression is managed through prescription and/or use of medications known as antidepressants.  A wide range of antidepressants has been availed for healthcare providers to choose from with the aim of delivering safe, high-quality, and person-centered care. However, different antidepressants are associated with unique set of side effects (U.S. Department of Health and Human Services, 2018).


            Psychotherapy is also referred to as talk therapy used for management or treatment of depressed persons. Some psychotherapeutic approaches are short-term in nature (that is 10 to 20 weeks); whereas other approaches are long term. Cognitive behavioral therapy (CBT) is one of the forms of talk therapies. CBT can help depressed adults to change behavior and/or negative thinking. Such behaviors and negative thinking may make depression worse. Another form of talk therapy known as interpersonal therapy helps depressed persons to manage and overcome troubling relationships, which may worsen or cause depression (U.S. Department of Health and Human Services, 2018).

Nursing Implications

            Depressed older adults educational need include lifestyle/behavioral changes and management of prescription medications; especially, if the patient is taking other medications for treatment of other disorders. Nurses need to educate patients about effective lifestyle and behavioral approaches that can result in improved management, prevention and/or improved prognosis of the condition. On the other hand, pharmacotherapeutic intervention to manage the condition as well as other underlying conditions may lead to polypharmacy issues. Polypharmacy increases the risk of adverse events including adverse drug-drug reactions and overdose issues. Besides, polypharmacy issues may contribute to poor adherence to the treatment plan since an older patient can be easily confused on which set of medications to take at what time and in what combinations (Hosseini et al., 2018; Mortazavi et al., 2016). As such, nurses need to educate patients on aspects such as lifestyle and behavioral changes as well as medication management for proper management of depression and/or other underlying conditions.

One research area that could be explored is alternative approaches, apart from pharmacotherapy, for prevention, management or treatment of depression among older adults. The rationale is that drug-associated harm is one of the most challenging public healthcare issues globally among the elderly people (Mortazavi et al., 2016).  These include psychotherapy, lifestyle changes, behavioural changes and ECT. However, more emphasis is on ECT since it is a revolutionary and innovative mode of treatment for managing depression. Further research and investigations on aspects such as efficacy, performance, safety, and ethical implications for using ECT among depressed older adults is highly recommended.

Ethical and Legal Implications

            Patient Protection Affordable Healthcare Act of 2010 has transformed mental health services in the U.S. However, structural barriers such as poor insurance coverage, costs, and attitudinal barriers should be addressed. These barriers may have negative impact in delivery of metal health services and care to older patients. Uninsured depressed people are less likely to receive treatment and other mental health services as opposed to those who are insured. Older adults who have depression may feel that their health care and treatment needs have not been met if they are not insured (Walker et al., 2015). In this context, nurses need to advocate for policy changes that will result in provision of a public funded healthcare insurance for all depressed older adults. In addition, ECT should be added onto the list of interventions that is gathered for by the federal- and state-funded healthcare insurance.

            Ethical considerations for management of depression, perhaps with ECT are informed by established ethical frameworks. These include the principle beneficence (acting in client’s or patient’s best interest), maleficence (do no harm or do not any intent of causing harm), and autonomy (respect patient’s decisions or respect for persons) (DeCamp et al., 2018). As such, further investigation and research will determine as to whether benefits of ECT use outweighs risks or adverse effects and on whether the intervention contributes to patient harm. With respect to respect of patient autonomy; depressed older patients must sign informed consent forms before the commence ECT. On the other hand, intervention measures may not be considered if the patient does not consent to use of ECT to manage their condition. This is because informed consent is a requirement when a patient is set to undergo a procedure such as ECT (DeCamp et al., 2018). On the other hand, a health care provider should also uphold and protect the confidentiality of patient information include patients social and medical history. 


            Depression is a common mental health disorder that can be managed or treated with various intervention approaches. Treatment intervention can be divided into two main categories, which are pharmacological and non-pharmacological approaches. Antidepressants are some of the major medications that are used in the management of depression. Non-pharmacologic approaches include ECT, lifestyle changes, behavioral changes, and psychotherapy. Beck’s theory better aligns with the appropriateness of ECT for management of depression among the elderly patient population who are diagnosed with depression. This is because development of depression during twilight years is frequently associated with organic causes that can be effectively and safely tackled with ECT. ECT is beneficial since it is safer as opposed to the use of medications. In addition, it has been demonstrated that ECT is one of the effective approaches for managing or treating depression among elderly patients.




Abdollahi, F., Lye, M-S., & Zarghami, M. (2016). Perspective of postpartum depression theories: A narrative literature review. N Am J Med Sci., 8(6), 232-236. DOI: 10.4103/1947-2714.185027.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-IV (5th ed.). Arlington, VA: American Psychiatric Association.

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., Reynolds, P.P., Sulmasy, L.S., & Tilburt, J. (2018). Ethical issues in the design and implementation of population health programs. J Gen Intern Med., 33(3), 370-375. DOI: 10.1007/s11606-017-4234-4.

Hosseini, S.R., Zabihi, A., Amiri, S.R.J., & Bijani, A. (2018). Polypharmacy among the elderly. J Midlife Health, 9(2), 97-103. DOI: 10.4103/jmh.JMH_87_17.

Kerner, N., & Prudic, J. (2014). Current electroconvulsive therapy practice and research in the geriatric population. Neuropsychiatry (London), 4(1), 33-54. DOI: 10.2217/npy.14.3.

Moledina, S.M., Bhimji, K.M., & Manji, K.P. (2018). Prevalence and associated factors of depression in an Asian community in DaresSalaam, Tanzania. Psychiatry, J., 2018, 9548471. DOI: 10.1155/2018/9548471. 

Mollard, E.K. (2014). A qualitative meta-synthesis and theory of postpartum depression. Issues Ment Health Nurs., 35(9), 656-63. DOI: 10.3109/01612840.2014.893044.

Mortazavi, S.S., Shati, M., Keshkar, A., Malakouti, S.K., Bazargan, M., & Assari, S. (2016).Defining polypharmacy in the elderly: a systematic review protocol. BMJ Open, 6, e010989. DOI:10.1136/bmjopen-2015-010989.

Padayacchey, U., Ramlall, S., & Chipps, J. (2017). Depression in older adults: prevalence and risk factors in a primary health care sample. South African Family Practice, 59(2), 61-66.

Tolentino, J.C., & Schmidt, S.L. (2018). DSM-5 criteria and depression severity: Implications for clinical practice. Front. Psychiatry. https://doi.org/10.3389/fpsyt.2018.00450

U.S. Department of Health and Human Services. (2018). National institute on aging. Retrieved on Nov 28, 2018 from, https://www.nia.nih.gov/health/depression-and-older-adults

Uher, R., Payne, J.L., Pavlova, B., & Perlis, R.H. (2014). Major depressive disorder in DSM-5: implications for clinical practice and research of changes from DSM-IV. Depress Anxiety, 31(6), 459-71. DOI: 10.1002/da.22217.

Walker, E.R., Cummings, J.R., Hockenberry, J.S., & Druss, B.G. (2015). Insurance status, use of mental health services, and unmet need for mental health care in the United States. Psychiatr Serv., 66(6), 578-584. DOI: 10.1176/appi.ps.201400248.


Related Samples

WeCreativez WhatsApp Support
Our customer support team is here to answer your questions. Ask us anything!
👋 Hi, how can I help?