The Efficacy of Acute Electroconvulsive Therapy in Atypical Depression

Abstract

Objective-This study examined the characteristics and outcomes of patients with major depressive disorder (MDD), with or without atypical features, who were treated with acute bilateral electroconvulsive therapy (ECT).Method-Analyses were conducted with 489 patients who met DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the basis of the Structured Clinical Interview for DSM-IV obtained at baseline prior to ECT. Depression symptom severity was measured by the 24-item Hamilton Rating Scale for Depression ) and the 30-item Inventory of Depressive Symptomatology-Self-Report ). Remission was defined as at least a 60% decrease from baseline in HAM-D 24 score and a total score of 10 or below on the last 2 consecutive HAM-D 24 ratings. The randomized controlled trial was performed from 1997 to 2004.Results-The typical (N = 453) and atypical (N = 36) groups differed in several sociodemographic and clinical variables including gender (p = .0071), age (p = .0005), treatment resistance (p = .0014), and age at first illness onset (p < .0001) and onset of current episode (p = . 0008). Following an acute course of bilateral ECT, a considerable portion of both the typical (67.1%) and the atypical (80.6%) groups reached remission. The atypical group was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group after adjustment for age, psychosis, gender, clinical site, and depression severity based on the HAM-D 24 .© Copyright 2008 Physicians Postgraduate Press, Inc.Corresponding author and reprints: Mustafa M. Husain, M.D., Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas,.. Drug names: lithium (Eskalith, Lithobid, and others), nortriptyline (Pamelor and others), phenelzine sulfate (Nardil). Disclosure of off-label usage:The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents that is outside U.S. Food and Drug Administration-approved labeling has been presented in this article. Conclusion-Acute ECT is an efficacious treatment for depressed patients with typical or atypical symptom features. NIH Public AccessThere is limited research examining the treatment of atypical depression with electroconvulsive therapy (ECT). Early research 1,2 suggested that ECT was ineffective in treating atypical depression. Although ECT resulted in minor improvement in mood, 2 many patients with atypical depressive features did not maintain the effect. However, neither study categorically defined atypical depression. They regarded atypical as being different from typical depression on the basis of undefined or varying symptom feature differences. Also, the study of West and Dally 2 was confounded by inclusion of patients who had primary anxiety disorders and secondary depression.While this early research has served as the basis for clinical decision making for decades, advances in both the understanding of atypical depression and the techniques involved in ECT recommend a reevaluation of...

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