Factors associated with early and late response to electroconvulsive therapy

Hart, Kamber L.; McCoy, Thomas H.; Henry, Michael E.; Seiner, Stephen J.; Luccarelli, James

doi:10.1111/acps.13537

Cited by 4 publications

(7 citation statements)

References 36 publications

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“…Instead, we have some observational data.In this issue, Hart et al report the results of a large (N = 1699; 59.6% female, 91.8% white), decade-long, single-site, retrospective cohort study, identifying predictors of early and late response. 3 The cohort comprised patients who had a moderate-severe unipolar (78.8%) or bipolar depressive episode with a baseline Quick Inventory of Depressive Symptomatology (QIDS) score > 10. Applying various dosing protocols, patients were treated with thrice-weekly ECT, using mostly (94.1%) right unilateral electrode placement with an ultrabrief pulse (0.3-0.37 ms) electrical stimulus.…”

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confidence: 99%

“…Of some help is that Hart et al's study indicates that switching to brief pulse unilateral ECT is helpful if not meeting a response criterion after five sessions of ultrabrief pulse ECT. 3 To provide some further guidance, a network meta-analysis, attempting to provide a ranking of various ECT "protocols" according to their comparative antidepressant efficacy and cognitive side-effect profile, is currently underway. 9 One possibility is that we will eventually have a clear hierarchy of switching strategies.…”

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confidence: 99%

“…In this issue, Hart et al report the results of a large ( N = 1699; 59.6% female, 91.8% white), decade‐long, single‐site, retrospective cohort study, identifying predictors of early and late response 3 . The cohort comprised patients who had a moderate–severe unipolar (78.8%) or bipolar depressive episode with a baseline Quick Inventory of Depressive Symptomatology (QIDS) score > 10.…”

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confidence: 99%

“…To investigate some or all of these would require a series of randomized controlled trials or possibly a large sequential adaptive trial. Of some help is that Hart et al's study indicates that switching to brief pulse unilateral ECT is helpful if not meeting a response criterion after five sessions of ultrabrief pulse ECT 3 . To provide some further guidance, a network meta‐analysis, attempting to provide a ranking of various ECT “protocols” according to their comparative antidepressant efficacy and cognitive side‐effect profile, is currently underway 9 …”

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confidence: 99%

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Changing tactics: Does switching improve electroconvulsive therapy outcomes?

Sienaert

McLoughlin

2023

Acta Psychiatr Scand

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Electroconvulsive therapy (ECT) is an evidence-based treatment for difficult-to-treat, severe and sometimes life-threatening depressive episodes. Its effectiveness and cognitive side-effects are modifiable by stimulus dose, electrode placement and stimulus pulse width. 1 Regarding efficacy, meta-analyses of contemporary randomized controlled trials tell us that brief pulse high-dose unilateral ECT is like brief pulse bitemporal ECT, while ultrabrief pulse high-dose unilateral ECT is less efficacious. However, ultrabrief pulse high-dose unilateral ECT has fewer cognitive side-effects than brief pulse high-dose unilateral ECT, which has less than brief pulse bitemporal ECT. 2 In patients showing response to ECT, improvement is mostly witnessed early in the treatment course. In patients not responding after four to six treatment sessions, it is common practice to change the technique, either by switching electrode position, prolonging pulse width, or increasing the stimulus dose. However, remarkably, no high-level randomized controlled trial data are available to robustly support any of these clinical ECT practices or guide when to implement them. Instead, we have some observational data.In this issue, Hart et al. report the results of a large (N = 1699; 59.6% female, 91.8% white), decade-long, single-site, retrospective cohort study, identifying predictors of early and late response. 3 The cohort comprised patients who had a moderate-severe unipolar (78.8%) or bipolar depressive episode with a baseline Quick Inventory of Depressive Symptomatology (QIDS) score > 10. Applying various dosing protocols, patients were treated with thrice-weekly ECT, using mostly (94.1%) right unilateral electrode placement with an ultrabrief pulse (0.3-0.37 ms) electrical stimulus. One third (N = 555; 33%) of the patients met the response criterion (i.e., a decrease in QIDS score ≥ 50% from baseline) at treatment number 5, while nearly a quarter (N = 397; 23.4%) responded after treatment number 5. In early non-responders, changing the treatment technique from ultrabrief-pulse to brief pulse (i.e., >0.37 ms) unilateral ECT resulted in a higher likelihood of being a responder as compared to continuing ultrabrief-pulse ECT. This tantalizingly suggests that, for patients being treated with unilateral ultrabrief-pulse ECT, changing the treatment technique

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confidence: 99%

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confidence: 99%

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Changing tactics: Does switching improve electroconvulsive therapy outcomes?

Sienaert

McLoughlin

2023

Acta Psychiatr Scand

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“…Individualized seizure threshold was determined at the time of first treatment, as previously reported 24,25 . Subsequent treatments were delivered initially at 6× seizure threshold for right unilateral treatments, typically three times weekly, with electrode placement and dose adjusted clinically by the treating psychiatrist based on response 26–28 . Methohexital was the default anesthetic agent with succinylcholine muscle relaxant, although etomidate, propofol, or ketamine anesthetic could be used at the discretion of the treating psychiatrist or anesthesiologist.…”

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confidence: 99%

Changes in self‐reported suicidal ideation during treatment with electroconvulsive therapy: A retrospective cohort study

Luccarelli,

Humphrey,

McCoy

et al. 2023

Acta Psychiatr Scand

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ObjectiveSuicidal ideation (SI) is common in patients with depressive symptoms, who are the most common recipients of electroconvulsive therapy (ECT). We sought to quantify changes in self‐reported SI occurring during treatment with ECT, and to identify factors associated with persistence of SI in patients beginning treatment with SI.MethodRetrospective, single‐center cohort study of patients receiving ECT and who self‐reported symptoms using Quick Inventory of Depressive Symptomatology (QIDS) prior to ECT and after treatment #5 or #10. Changes in QIDS‐reported SI over the course of ECT were calculated, and logistic regression models were performed to assess factors associated with reporting SI at the end of treatment.Results2554 provided baseline and follow‐up SI scores, of whom, 1931 (75.6%) endorsed SI at baseline. There was a reduction in SI with ECT treatment (McNemar's test; df = 1, Χ2 = 803.7; p < 0.001), and in adjusted models 64.0% of individuals with baseline SI reported resolution of SI with ECT treatment, while 3.3% without baseline SI reported SI at the end of treatment. Higher baseline SI severity and outpatient treatment were associated with a higher odds of persistent SI among individuals beginning treatment with SI.ConclusionElectroconvulsive therapy treatment was associated with reductions in self‐reported SI. These results support the use of ECT in the treatment of patients with SI, but further research is needed to determine the effects of ECT on suicidal behavior.

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