Clinical Outcome of ECT in Patients With Major Depression and Comorbid Borderline Personality Disorder

Feske, Ulrike

doi:10.1176/appi.ajp.161.11.2073

Cited by 98 publications

(83 citation statements)

References 39 publications

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“…The sample under study has not been evaluated for Axis II disorders, which might have confounded the present results (e.g. Feske et al 2004). Furthermore, a large age range (23-81 yr) of the present sample including elderly patients has to be acknowledged with a significantly better response to ECT in older patients, which is in line with a multi-site longitudinal study (CORE) showing older age to confer a greater likelihood of achieving remission under ECT (O'Connor et al 2001) and another study reporting even the oldest depressed patients to respond to ECT equally well or even better than younger patients (Tew et al 1999).…”

Section: Discussionmentioning

confidence: 99%

Dopamine D3 receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression

Dannlowski

Domschke

Birosova

et al. 2013

International Journal of Neuropsychopharmacology

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Dysfunction of dopamine D₃ receptors, particularly in the mesocorticolimbic system, has been linked to the pathogenesis of major depression. Preclinical data show enhanced D₃ receptor binding in the striatum upon antidepressant medication and electroconvulsive therapy (ECT). Thus, the potential impact of dopamine D₃ receptor gene (DRD3) variation on ECT outcome in treatment-resistant major depression was evaluated by applying a combined molecular and imaging genetic approach. Altogether, 10 representative variants covering 95.4% of DRD3 gene variation were investigated for association with response to ECT in a sample of 104 (71 female, 33 male) Caucasian patients with pharmacorefractory major depression. Additionally, ventral striatum responsiveness to happy faces was assessed in two independent samples of depressed patients (total N=54) by means of functional magnetic resonance imaging at 3 T. Significant association of DRD3 rs3732790, rs3773679 and rs9817063 variants with response (uncorrected p=0.02-0.03) and remission (uncorrected p=0.01) after ECT was discerned. Logistic regression analyses revealed association of rs3732790 (uncorrected p=0.009; corrected p=0.045) and rs3773679 (uncorrected p=0.009; corrected p=0.045) with remission when applying a recessive model of inheritance. The rs3732790T allele conferring a more favourable treatment response was furthermore found to be associated with stronger striatal responsiveness to happy facial expressions (sample 1: cluster-corrected p=0.002; sample 2: p=0.023). In summary, the present study suggests some impact of DRD3 gene variation on ECT response, potentially mediated by alteration of striatal engagement during the processing of emotionally rewarding stimuli.

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Section: Discussionmentioning

confidence: 99%

Dopamine D3 receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression

Dannlowski

Domschke

Birosova

et al. 2013

International Journal of Neuropsychopharmacology

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“…Untreated comorbid anxiety symptoms might be a predictor of relapses of mood disorders. Comorbidity of personality disorder was also reported to show less response to ECT (42). The results of this study revealed that comorbidity should be kept in mind as a remarkable risk factor for high relapse/recurrence rates.…”

Section: Discussionmentioning

confidence: 56%

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Çakιr¹,

Çağlar²

2017

Arch Neuropsychiatr

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Introduction: Electroconvulsive therapy (ECT) is known to be an effective option in the treatment of mood disorders, especially resistant depression. However, the remission achieved by ECT was reported to be not long lasting enough. The aim of the present study was to investigate the relapse/recurrence rates and associated risk factors during the first year after ECT in patients diagnosed with mood disorders.Methods: In a naturalistic observation, patients diagnosed with unipolar depressive disorder or a depressive episode of bipolar disorder and who had achieved remission by ECT were followed up for at least one year. The patients were evaluated with structured interviews during the follow-up period. The relapse/recurrence rates were the primary outcome measurements, while hospitalization and suicide attempts were the secondary outcome measurements. The remitted and non-remitted patients were compared regarding the clinical features, ECT, and pharmacological variables.Results: Fifty of 62 patients who had achieved remission with ECT completed the one year follow-up period. Thirty-three patients (66%) had relapse/recurrence, while 17 (34%) patients remained in remission. The relapse rates were similar in patients with unipolar depression and bipolar disorders. The mean number of ECT sessions was higher in relapsed patients with bipolar disorders. Multiple episodes were more frequent in non-remitted patients with unipolar depression. Comorbid psychiatric diagnosis was higher in non-remitted patients with unipolar and bipolar disorders. Conclusion:The relapse/recurrence rate was found to be fairly high in the first year of follow-up in patients who had achieved remission with ECT. ECT decisions should be made carefully in patients with comorbid psychiatric diagnosis and multiple episodes as these are more risky. The ECT application procedure and successive maintenance treatment (maintenance ECT, pharmacotherapy, and psychotherapy) should be planned to sustain the remission for patients with mood disorders in long-term follow-up.Keywords: Electroconvulsive therapy, mood disorders, relapse, remission, major depression Arch Neuropsychiatry 2017; 54: 196-201 • DOI: 10.5152/npa.2016.14845 Electroconvulsive ABSTRACT INTRODUCTONThe efficacy of pharmacotherapy in mood disorders is not satisfactory, and the desired remission rates are not currently achieved in either unipolar (UD) or bipolar disorders (BP) (1,2,3). Electroconvulsive therapy (ECT) has been used for a long time with successful response and remission rates; 80-90% of patients experience an improvement, and the efficacy of ECT has been established to be between 60% and 90% regarding acute response in treatment-resistant depression (3,4,5,6,7). ECT is also considered to be an effective treatment in bipolar depression and is indicated to be equally effective in unipolar and bipolar depression (8,9,10). The effectiveness of ECT in the treatment of UD and BP has also been reported, and it is recommended by guidelines (11,12,13,14). However, the literature data...

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“…Bilateral ECT was shown to be more effective than unilateral ECT (22 7 RCT, 1,408 patients) and high dosage procedures are superior than low dosage ones (seven RCT, 342 patients). According to a recent RCT, 87 comorbidity with borderline personality disorder implies less short-term response to the depression symptomatology.…”

Section: Efficacymentioning

confidence: 99%

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica

Moser

Lobato

Belmonte-de-Abreu

2005

Rev. psiquiatr. Rio Gd. Sul

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A eletroconvulsoterapia (ECT) consiste em tratamento biológico ainda não amplamente utilizado na prática psiquiátrica, devido aos inúmeros fatores que contribuem para uma resistência acerca do método. Objetivando sustentar, com embasamento científico, o emprego da ECT, agregamos evidências de sua eficácia, indicações, contra-indicações e efeitos adversos, advindas dos principais ensaios clínicos randomizados e meta-análises disponíveis na literatura médica atual sobre o tema (PubMed/MEDLINE, Cochrane).

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Clinical Outcome of ECT in Patients With Major Depression and Comorbid Borderline Personality Disorder

Abstract: Patients with borderline personality disorder have a poorer acute response to ECT, but explanations for this finding remain elusive.

Cited by 98 publications

References 39 publications

Dopamine D3 receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression

Dopamine D3 receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica

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