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

Medda, Pierpaolo; Mauri, Mauro; Toni, Cristina; Mariani, Michela Giorgi; Rizzato, Salvatore; Simone, Luigi De; Perugi, Giulio

doi:10.1097/yct.0000000000000119

Cited by 15 publications

(6 citation statements)

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“…In total, 34 articles were selected and used in this meta-analysis. [41][42][43][44][45][46][47][48][49][50][51][52][53] The interrater reliability was good, with an interrater agreement of 96.1% (kappa (κ) = 0.87, 95% CI 0.78-0.96).…”

Section: Selection Of Studiesmentioning

confidence: 99%

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

et al. 2018

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Section: Selection Of Studiesmentioning

confidence: 99%

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

et al. 2018

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“…Given the cost and potential side effects of ECT, an improved understanding of predictors of ECT response would help guide referral for ECT treatment. Multiple prior studies have explored factors associated with response to ECT, with factors including older age, presence of psychotic symptoms, and increased severity of depression being associated with improved response 3–7 . These studies, however, have had limited sample sizes, and meta‐analyses have been challenged by the heterogeneity of study design including variations in the definition of remission/response as well as the specific predictors included in the analysis 8 .…”

Section: Introductionmentioning

confidence: 99%

“…factors associated with response to ECT, with factors including older age, presence of psychotic symptoms, and increased severity of depression being associated with improved response. [3][4][5][6][7] These studies, however, have had limited sample sizes, and meta-analyses have been challenged by the heterogeneity of study design including variations in the definition of remission/response as well as the specific predictors included in the analysis. 8 Additionally, many studies focus on predictors of short-term response to ECT over a few treatments, without examining predictors that predict response over a greater number of treatments.…”

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“…3,9 ECT administration can involve multiple different electrode placements (unilateral, bitemporal, bifrontal) and electrical pulse widths (ultrabrief pulse or brief pulse), which may vary in efficacy and tolerability. While many prospective research studies specify these ECT parameters a priori, [3][4][5] in clinical practice there is greater heterogeneity in ECT parameter utilization, and clinicians may make changes to a patient's ECT regimen over the course of a treatment series. Despite this common practice, the effect of changes in ECT parameters during a treatment course has been little explored, and there have not been prospective trials comparing changes in ECT parameters among patients who do not initially respond to treatment.…”

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Factors associated with early and late response to electroconvulsive therapy

Hart

McCoy

Henry

et al. 2023

Acta Psychiatr Scand

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Objective: Electroconvulsive therapy (ECT) is an effective treatment for severe depressive symptoms, yet more research is needed to examine predictors of treatment response, and factors associated with response in patients not initially improving with treatment. This study reports factors associated with time to response (early vs. late) to ECT in a real-world setting.Methods: This was a retrospective, single-center cohort study of patients endorsing moderate to severe depressive symptoms using the Quick Inventory of Depressive Symptomatology (QIDS; QIDS>10). Response was defined as 50% or greater decrease in QIDS score from baseline. We used logistic regression to predict response at treatment #5 (early response) as well as after treatment #5 (late response) and followed patients through ECT discontinuation or through treatment #20.Results: Of the 1699 patients included in this study, 555 patients (32.7%) responded to ECT treatment at treatment #5 and 397 (23.4%) responded after treatment #5. Among patients who did not respond by treatment #5, those who switched to brief pulse width ECT from ultrabrief pulse ECT had increased odds of response after treatment #5 compared with patients only receiving ultrabrief pulse (aOR = 1.55, 95% CI: 1.16-2.07). Additionally, patients with less improvement in QIDS from baseline to treatment #5 had decreased odds of response after treatment #5 (aOR = 0.97, 95% CI = 0.97-0.98). Conclusion:Among depressed patients treated with ECT, response occurred in 56.0% of patients by treatment #20. Patient receiving ultrabrief pulse ECT at baseline and who did not respond by treatment #5 had greater odds of subsequent response if switched to brief pulse ECT than if continued with ultrabrief pulse.affective disorders, cohort studies, electroconvulsive therapy, real world evidence | INTRODUCTIONElectroconvulsive therapy (ECT) is an effective treatment for severe depressive symptoms, with reported remission rates ranging from 50% to 70%. 1,2 Given the cost and potential side effects of ECT, an improved understanding of predictors of ECT response would help guide referral for ECT treatment. Multiple prior studies have explored

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“…Forty seven of the 89 were observational studies (Azuma et al, 2011;Bär et al, 2010;Bayless et al, 2010;Beall et al, 2012;Bersani et al, 2014;Bilgen et al, 2014;Burgese & Bassitt, 2015;Casarotto et al, 2013;Chiaie et al, 2013;Dannlowski et al, 2013;Dukart et al, 2014;Ebert et al, 2010;Galletly, Paterson, & Burton, 2012;Goto et al, 2012;Guloksuz et al, 2015;Hu et al, 2010;Johansson, Ehnvall, Friberg, & Myredal, 2010;Joshi et al, 2015;Kalogerakou et al, 2015;Kautto et al, 2015;Lin et al, 2013;Loo, Mahon, Katalinic, Lyndon, & Hadzi-Pavlovic, 2011;Lucca et al, 2010;Lyden et al, 2014;McCall et al, 2013;Medda et al, 2014;Meeter, Murre, Janssen, Birkenhager, & van den Broek, 2011;Minelli et al, 2014;Nickl-Jockschat et al, 2015;Nordanskog, Larsson, Larsson, & Johanson, 2014;Ota et al, 2015;Oudega et al, 2011;Perrin et al, 2012;Piccinni et al, 2013;Rapinesi et al, 2015;Rapinesi et al, 2013;Royster et al, 2012;Saijo et al, 2010;Samuelsson, Gerdin, Öllinger, & Vrethem, 2012;Tendolkar et al, ...…”

Section: Focus and Design Of The 91 Studiesmentioning

confidence: 99%

Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009

Read

Arnold

2017

Ethical Hum Psychol Psychiatry

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Is electroconvulsive therapy for depression more effective than placebo? A systematic review of studies since 2009. ABSTRACTBackground: A 2010 review of studies and previous reviews and meta-analyses found minimal evidence that ECT for depression was more effective than placebo during the treatment period and no evidence at all of efficacy beyond the end of treatment. The current review explored whether any contradictory evidence has since been generated. Method: MEDLINE and PsycINFO were searched to identify all post 2009 studies that had compared ECT and simulated ECT for depression, or had in any other way generated valid depression data for ECT recipients at two or more points in time. Results: Ninety-one studies met inclusion criteria. There were no new placebo-controlled trials. There have now been no such studies since 1985. Only four placebo-controlled studies have ever produced data beyond the end of treatment, none of which had found any advantage for ECT over placebo. Of the 91 studies only two aimed to evaluate the efficacy of ECT. Both were severely flawed. None of the other 89 produced robust evidence that ECT is effective for depression, primarily because at least 60% maintained ECT participants on medication and 89% produced no meaningful follow up data beyond the end of treatment. No studies investigated whether ECT prevents suicide. Conclusions: There is still no evidence that ECT is more effective than placebo for depression reduction or suicide prevention. Given the 1 well-documented high risk of persistent memory dysfunction, the cost-benefit analysis for ECT remains so poor that its use cannot be scientifically, or ethically, justified.

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

Abstract: Major depressive disorder, short duration of the current episode, absence of psychotic symptoms, preserved insight, and adequate personal care are associated with complete remission in our sample of drug-resistant depressive patients treated with ECT.

Cited by 15 publications

References 37 publications

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

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

Factors associated with early and late response to electroconvulsive therapy

Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009

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