Predictors of Remission After Electroconvulsive Therapy in Unipolar Major Depression

Abstract

Context: Electroconvulsive therapy (ECT) is the most effective biological treatment for major depression. However, there is little agreement about clinically useful predictors of acute ECT outcomes. Objective: To assess whether age, sex, burden of comorbid physical illness, age at onset, history of recurrence, episode duration, chronic depression or comorbid dysthymia, melancholic features, episode severity, and medication resistance are predictors of remission after an acute course of ECT. Design: We performed an analysis using data gathered prospectively in 328 patients with unipolar major depression (according to Research Diagnostic Criteria) treated with ECT. The study was conducted from 1993 through 1999. Patients had a pretreatment score of 21 or higher on the 24-item Hamilton Rating Scale for Depression (HAM-D). Treatment history was assessed using the Antidepressant Treatment History Form. Remission was defined as a 24-item HAM-D score of 10 or less and a 60% or more relative reduction of the HAM-D score. Results: On univariate logistic regression, statistically significant predictors of nonremission were chronic depression/dysthymia, medication resistance, longer episode duration, and younger age. On backward elimination logistic regression, only medication resistance (OR = 1.67, 95% CI = 1.05 to 2.67) and chronic depression/ dysthymia (OR = 1.84, 95% CI = 1.06 to 3.21) were statistically significant predictors of nonremission. Conclusions: In patients with major depression, lower rates of remission after acute ECT are associated with medication resistance and chronicity, but not with age or burden of physical illness.

Predictors of the short-term responder rate of Electroconvulsive therapy in depressive disorders - a population based study

“…It is difficult to explain why some earlier smaller studies have reported less positive outcome in patients with psychotic depression [8,9]. However, the result from this study is robust and the reported responder rate in psychotic depression is very high.…”

“…Presence of psychotic symptoms[3,6], lower degree of prior treatment resistance [7-9] and shorter symptom duration [8,10] are relatively well established predictors of response to ECT [11]. In addition, the CORE group reported depression in old age to be associated with a favorable outcome [12].…”

Predictors of Remission in 208 Drug-Resistant Depressive Patients Treated With Electroconvulsive Therapy

“…2,44 Studies examining speed of response have generally found that patients with bipolar depression showed a more rapid response and required fewer ECT treatments than patients with MDD 1,3,45,46 In the present study, the association of remission with shorter length of the depressive episode is consistent with previous reports that a longer duration of depression predicted a lower response rate to ECT. [47][48][49][50] From our study, it is not possible to infer whether some patients are intrinsically resistant to treatment and have prolonged episodes for that reason or whether ineffective treatments, in prolonging the episode, contribute to an active process that makes patients difficult to treat. 51 Number of lifetime days spent in depression has been associated with the degree of hippocampal atrophy, implicating an active degenerative process.…”

Mode of action of electroconvulsive therapy: an update

“…Perhaps the most important observation for prescribers is that a failure of patients with depression to recover with a selective serotonin reuptake inhibitor or a monoamine oxidase inhibitor has no bearing on the probability of remission with subsequent ECT. In contrast, a failure to recover with a tricyclic antidepressant drug or bupropion reduces the probability of recovery with subsequent ECT; nevertheless, a half of such patients will recover with ECT (Dombrovski 2005).…”