ECT in bipolar and unipolar depression: differences in speed of response

Daly, James J.; Prudic, Joan; Devanand, D. P.; Nobler, Mitchell S.; Lisanby, Sarah H.; Peyser, Shoshana; Roose, Steven P.; Sackeïm, Harold A.

doi:10.1034/j.1399-5618.2001.030208.x

Cited by 162 publications

(111 citation statements)

References 32 publications

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“…As similar to this study and other studies, ECT has the highest response rate of all treatments for acute episodes of bipolar depression and major depression 15,16,17 14 ) do not differentiate bipolar from unipolar depression and the indications remain the same in both-emergency treatment needing rapid and definitive response, pregnant women with depression, high suicidal risk, patients with good response to ECT, severe psychomotor retardation, poor response of drugs in the past. Most importantly, patient and their relatives may also choose ECT as treatment for their depression.…”

Section: Resultsupporting

confidence: 75%

Electroconvulsive therapy in mood diorders

Adhikari

2015

J Chitwan Med Coll

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Electroconvulsive therapy (ECT) is one of the less used somatic treatments in mood disorders, especially depressive phase. ECT use has importance during acute bipolar episode when patient extremely violent, suicidal and extreme psychomotor retardation. The aim of this study was to know about socio-demographic profile and therapeutic efficacy of the use of ECT in mood disorders. Methods: This is a prospective comparative study between patients who received ECT and who did not. Psychopathology was evaluated using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) between the groups at admission, at discharge, at 1st month, at 6th month and at 12th month. Modified ECT was performed using general anesthetic agent. Results: Twenty five patients received ECT as compared to 32 patients who were non-receivers. There was significant decrease in HDRS in ECT receiver as compared to non-receivers in patients with depression (both unipolar and bipolar) at discharge, 1st month, and 12th month; in YMRS in patient with mania at discharge, 1st month and at 12th month. Discussion: There was significant improvement in overall psychopathology and psycho-social status of patients who received ECT as compared to non-receivers. The improvement was shown by decrement in scores in HDRS and YMRS at the time of discharge, 1st month, 6th month and 1st year which were statistically significant.

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Section: Resultsupporting

confidence: 75%

Electroconvulsive therapy in mood diorders

Adhikari

2015

J Chitwan Med Coll

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“…Electroconvulsive therapy (ECT), for example, typically results in remission in 1-3 weeks (Daly et al, 2001), whereas Interpersonal Psychotherapy (IPT) (Klerman et al, 1984) or Cognitive Therapy (CBT) (Beck et al, 1979) may take 6-10 weeks. With medications, remission may begin within 4-12 weeks (or longer) after beginning treatment (O'Leary et al, 2000;Chilvers et al, 2001;Trivedi et al, 2001Trivedi et al, , 2006Quitkin et al, 2003).…”

Section: Factors Affecting Remissionmentioning

confidence: 99%

Report by the ACNP Task Force on Response and Remission in Major Depressive Disorder

Rush¹,

Kraemer

Sackeïm

et al. 2006

Neuropsychopharmacol

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595

489

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This report summarizes recommendations from the ACNP Task Force on the conceptualization of remission and its implications for defining recovery, relapse, recurrence, and response for clinical investigators and practicing clinicians. Given the strong implications of remission for better function and a better prognosis, remission is a valid, clinically relevant end point for both practitioners and investigators. Not all depressed patients, however, will reach remission. Response is a less desirable primary outcome in trials because it depends highly on the initial (often single) baseline measure of symptom severity. It is recommended that remission be ascribed after 3 consecutive weeks during which minimal symptom status (absence of both sadness and reduced interest/pleasure along with the presence of fewer than three of the remaining seven DSM-IV-TR diagnostic criterion symptoms) is maintained. Once achieved, remission can only be lost if followed by a relapse. Recovery is ascribed after at least 4 months following the onset of remission, during which a relapse has not occurred. Recovery, once achieved, can only be lost if followed by a recurrence. Day-to-day functioning and quality of life are important secondary end points, but they were not included in the proposed definitions of response, remission, recovery, relapse, or recurrence. These recommendations suggest that symptom ratings that measure all nine criterion symptom domains to define a major depressive episode are preferred as they provide a more certain ascertainment of remission. These recommendations were based largely on logic, the need for internal consistency, and clinical experience owing to the lack of empirical evidence to test these concepts. Research to evaluate these recommendations empirically is needed.

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“…In the study of Sienaert et al, 5 bipolar depressed patients (n = 13) required approximately 7-8 treatments to achieve response or remission status, whereas unipolar depressed patients (n = 51) required, on average, 9-11 treatments to achieve response or remission. Likewise, in a reanalysis of data by Daly et al, 6 bipolar patients (n = 66) showed a 54.9% reduction (SD = 31.9%) in HDRS score compared with a 43.9% reduction (SD = 29.8%) among unipolar patients (n = 162) after 6 ECT treatments.…”

mentioning

confidence: 86%

Electroconvulsive Therapy for Bipolar Disorder: Evidence Supporting What Clinicians Have Long Known

Kellner

Ahle²,

Geduldig³

2015

J. Clin. Psychiatry

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T he effectiveness of electroconvulsive therapy (ECT) as an acute antidepressant is well known; less commonly known is the effectiveness of ECT as a mood stabilizer, that is, as an antimanic treatment, and by extension, an antimixed state treatment. In this issue of the Journal, Medda and colleagues' 1 report of the high effectiveness of ECT in a cohort of nearly 200 bipolar patients with mixed affective states adds important evidence to this knowledge base. In this commentary, we review the evidence for the effectiveness of ECT in all phases of bipolar disorder.There is no reason to suspect that ECT would be any less effective for bipolar depression than for unipolar depression, yet this remains a commonly held belief. Similarly, many practitioners seem to think that there is only meager evidence for ECT's effectiveness in bipolar depression, but this is untrue. There is a long history of clinical use of ECT for bipolar depression and a systematic evidence base that is catching up with this experience.In a study of the efficacy of ECT in a cohort of 220 unipolar (n = 170) and bipolar (n = 50) depressed patients, Bailine et al 2 found no significant difference in remission rates between the 2 groups when remission was defined as a score of less than or equal to 10 on the 24-item Hamilton Depression Rating Scale (HDRS 24 ). Similarly, recent studies by Dierckx et al 3 and Narayanaswamy et al 4 comparing ECT response and remission rates among bipolar and unipolar depressed patients found no significant difference in the efficacy of ECT. Some studies have also shown that bipolar depressed patients require fewer treatments to achieve "responder" or "remitter" status. In the study of Sienaert et al, 5 bipolar depressed patients (n = 13) required approximately 7-8 treatments to achieve response or remission status, whereas unipolar depressed patients (n = 51) required, on average, 9-11 treatments to achieve response or remission. Likewise, in a reanalysis of data by Daly et al, 6 bipolar patients (n = 66) showed a 54.9% reduction (SD = 31.9%) in HDRS score compared with a 43.9% reduction (SD = 29.8%) among unipolar patients (n = 162) after 6 ECT treatments. Medda et al7 reviewed the efficacy of ECT in all 3 depressive subtypes; response rates were high for all (unipolar, 88.2%, n = 17; bipolar I, 69.6%, n = 67; and bipolar II, 73.1%, n = 46). However, bipolar I depressed patients exhibited higher residual manic and psychotic symptomatology, as measured by the Young Mania Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS).Electroconvulsive therapy has long been used as a "rescue" treatment for refractory mania. In contemporary psychiatric practice, most, even severely, manic patients eventually respond to pharmacotherapy-usually a combination of mood stabilizers and tranquilizers, often at high doses. For those who do not, ECT is an important and usually quickly effective alternative treatment.In a review of the use of ECT in mania over a period of 50 years, Mukherjee et al 8 concluded that 80% of 589 manic ...

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ECT in bipolar and unipolar depression: differences in speed of response

Cited by 162 publications

References 32 publications

Electroconvulsive therapy in mood diorders

Electroconvulsive therapy in mood diorders

Report by the ACNP Task Force on Response and Remission in Major Depressive Disorder

Electroconvulsive Therapy for Bipolar Disorder: Evidence Supporting What Clinicians Have Long Known

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