Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis

Diermen, Linda van; Ameele, Seline van den; Kamperman, Astrid M.; Sabbe, Bernard; Vermeulen, Tom; Schrijvers, Didier; Birkenhäger, Tom K.

doi:10.1192/bjp.2017.28

Cited by 210 publications

(176 citation statements)

References 63 publications

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“…confirmed this and also concluded that a shorter episode duration was a good outcome predictor . In our 2018 meta‐analysis, we found three additional clinical predictors of good outcome: old age, presence of psychotic symptoms and higher baseline severity of depressive symptoms .…”

Section: Introductionsupporting

confidence: 78%

“…To calculate the results for the three MSM factors with an alleged predictive effect (episode duration, depression severity and the number of failed antidepressants during the current episode), we used the scoring method prescribed by the model (see Treatment resistance section).…”

Section: Resultsmentioning

confidence: 99%

“…However, its overall clinical use is limited due to its potential cognitive side‐effects , its limited availability and its limited acceptability to a proportion of patients. Furthermore, response to ECT varies between 65% and 80% . In the last few decades, numerous predictors of ECT outcome have been proposed.…”

Section: Introductionmentioning

confidence: 99%

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The Maudsley Staging Method as predictor of electroconvulsive therapy effectiveness in depression

Diermen

Hebbrecht

Schrijvers

et al. 2018

Acta Psychiatr Scand

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Objective: To investigate the potential role of the Maudsley Staging Method (MSM) in the prediction of electroconvulsive therapy (ECT) outcome in severely depressed adults. Method: Between August 2015 and August 2017, 73 consecutive patients with a major depressive episode (DSM-IV-TR) scheduled for ECT were recruited. Prior to their first ECT session, the MSM was completed to assess the level of therapy resistance. To determine the reduction in depression severity and response and remission rates, symptom severity was assessed at baseline and within one week after the last ECT session using the 17-item Hamilton Depression Rating Scale (HDRS17). Results: The percentage of symptom reduction following ECT was best predicted by the MSM episode duration and depression severity factors (R 2 completer sample 0.24). Episode duration alone was the best predictor of remission (area under the ROC curve for completers: 0.72). Adding age to the models increased their predictive capacity. Conclusion: An adapted version of the MSM gauging shorter episode duration, more severe depressive symptoms and older age is significantly associated with ECT effectiveness in adults with severe recurrent depression and is thus highly suitable for use in clinical practice, promoting the shared treatment decision-making process. Significant outcomes• The percentage of HDRS decrease can be predicted by an adapted version of the MSM, evaluating baseline depression severity and episode duration.• Remission was best predicted by depressive episode duration.• Adding age to the models improved their predictive capacities. • The adapted MSM has the potential to contribute to the treatment decision-making process in patients with depression. Limitations• Although the adapted MSM is a significant predictor, it can only explain part of ECT effectiveness.• The sample size of our study is limited. • Due to our observational design, there is substantial heterogeneity in patient and treatment characteristics.

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Section: Introductionsupporting

confidence: 78%

Section: Resultsmentioning

confidence: 99%

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The Maudsley Staging Method as predictor of electroconvulsive therapy effectiveness in depression

Diermen

Hebbrecht

Schrijvers

et al. 2018

Acta Psychiatr Scand

Self Cite

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“…But from a clinical point of view, ECT can be a first‐line treatment for patients in urgent clinical situations, including acute suicidality or malnutrition (Jaffe, ). ECT is also particularly effective in patients with major depressive disorder (MDD) with psychotic features and in elderly adults with MDD (van Diermen et al, ). Despite the efficacy of ECT, the neurobiological underpinnings and the mechanisms underlying symptom improvement of ECT‐induced antidepressant response remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Electroconvulsive therapy treatment responsive multimodal brain networks

Abbott

Narr

et al. 2020

Human Brain Mapping

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Electroconvulsive therapy is regarded as the most effective antidepressant treatment for severe and treatment‐resistant depressive episodes. Despite the efficacy of electroconvulsive therapy, the neurobiological underpinnings and mechanisms underlying electroconvulsive therapy induced antidepressant effects remain unclear. The objective of this investigation was to identify electroconvulsive therapy treatment responsive multimodal biomarkers with the 17‐item Hamilton Depression Rating Scale guided brain structure–function fusion in 118 patients with depressive episodes and 60 healthy controls. Results show that reduced fractional amplitude of low frequency fluctuations in the prefrontal cortex, insula and hippocampus, linked with increased gray matter volume in anterior cingulate, medial temporal cortex, insula, thalamus, caudate and hippocampus represent electroconvulsive therapy responsive covarying functional and structural brain networks. In addition, relative to nonresponders, responder‐specific electroconvulsive therapy related brain networks occur in frontal‐limbic network and are associated with successful therapeutic outcomes. Finally, electroconvulsive therapy responsive brain networks were unrelated to verbal declarative memory. Using a data‐driven, supervised‐learning method, we demonstrated that electroconvulsive therapy produces a remodeling of brain functional and structural covariance that was unique to antidepressant symptom response, but not linked to memory impairment.

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“…Other patients are unable to tolerate antidepressant medications [2,3]. Although treatments such as electroconvulsive therapy (ECT) are highly efficacious [4][5][6], tolerability of ECT can be low due to potential cognitive side effects [7]. Newer magnetic stimulation treatments such as repetitive transcranial magnetic stimulation (rTMS) have shown clinical efficacy, reproduced in meta-analyses [8][9][10], and have a better side effect profile than ECT and many medications.…”

Section: Introductionmentioning

confidence: 99%

A Double-Blind Pilot Dosing Study of Low Field Magnetic Stimulation (LFMS) for Treatment-Resistant Depression (TRD)

Dubin

Ilieva

Deng³

et al. 2018

Preprint

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and I. Ilieva contributed equally to this work. AbstractLow Field Magnetic Stimulation is a potentially rapid-acting treatment for depression with moodenhancing effects in as little as one 20-minute session. The most convincing data for LFMS has come from treating bipolar depression. We examined whether LFMS also has rapid mood-enhancing effects in treatment-resistant major depressive disorder, and whether these effects are dose-dependent. We hypothesized that a single 20-min session of LFMS would reduce depressive symptom severity and that the magnitude of this change would be greater after three 20-min sessions than after a single 20min session. In a double-blind randomized controlled trial, 30 participants (age 21-65) with treatmentresistant depression were randomized to three 20-minute active or sham LFMS treatments with 48 hours between treatments. Response was assessed immediately following LFMS treatment using the 6-item Hamilton Depression Rating Scale (HAMD-6), the Positive and Negative Affect Scale (PANAS) and the Visual Analog Scale. Following the third session of LFMS, the effect of LFMS on VAS and HAMD-6 was superior to sham (F (1, 24) = 7.45, p = 0.03, Holm-Bonferroni corrected; F (1, 22) = 6.92, p = 0.03, Holm-Bonferroni corrected, respectively). There were no differences between sham and LFMS following the initial or second session with the effect not becoming significant until after the third session. Three 20-minute LFMS sessions were required for active LFMS to have a mood-enhancing effect for individuals with treatment-resistant depression. As this effect may be transient, future work should address dosing schedules of longer treatment course as well as biomarker-based targeting of LFMS to optimize patient selection and treatment outcomes.

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Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis

Cited by 210 publications

References 63 publications

The Maudsley Staging Method as predictor of electroconvulsive therapy effectiveness in depression

The Maudsley Staging Method as predictor of electroconvulsive therapy effectiveness in depression

Electroconvulsive therapy treatment responsive multimodal brain networks

A Double-Blind Pilot Dosing Study of Low Field Magnetic Stimulation (LFMS) for Treatment-Resistant Depression (TRD)

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