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

Abstract

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.

Effects of Electroconvulsive Therapy on Depression and Its Potential Mechanism

“…However, no studies have confirmed differences in cognitive profiles between patients, partially due to the heterogeneity of the clinical demonstrations. Moreover, although more advanced protocols were introduced, bioinformatics yielded predictions of the response of ECT that are scattered and lack comprehensive measurements (Husain et al, 2004;Redlich et al, 2016;van Diermen et al, 2018;Birkenhager et al, 2019;Foo et al, 2019;Nuninga et al, 2019;Omori et al, 2019). Additionally, even though ECT has been shown to be harmless and effective, the application rate is still low and it is considered the last resort in treating depression (Liang et al, 2017;Osler et al, 2018).…”

“…Apart from non-CORE/PRIDE, the studies above indicate that older age, male, and with baseline cognitive decline were predictors of a preferable response and less likelihood of a relapse (Socci et al, 2018;van Diermen et al, 2018). Contrariwise, depressed individuals who were young, female, and with a history of non-suicidal self-injury were more likely to be resistant to ECT (Socci et al, 2018;Rootes-Murdy et al, 2019).…”

“…Comprehensive bioinformatics is assumed to be able to predict who is likely to benefit from ECT. It has been suggested that unipolar depressed patients with psychotic symptoms were more likely to respond to ECT and the elderly were more likely to reach remission (Husain et al, 2004;Socci et al, 2018;van Diermen et al, 2018). Additionally, the Maudsley Staging Method confirmed that shorter episode duration and more severe depressive symptoms predicted a favorable outcome (van Diermen et al, 2018).…”

“…It has been suggested that unipolar depressed patients with psychotic symptoms were more likely to respond to ECT and the elderly were more likely to reach remission (Husain et al, 2004;Socci et al, 2018;van Diermen et al, 2018). Additionally, the Maudsley Staging Method confirmed that shorter episode duration and more severe depressive symptoms predicted a favorable outcome (van Diermen et al, 2018). As a result of the overall prevalence of female depressed individuals, the number of female depressed patients who participated in ECT was greater than male (Liang et al, 2017;Slade et al, 2017;McCall et al, 2018).…”

“…In short, in the elderly (Husain et al, 2004), psychotic symptom comorbidities (Husain et al, 2004), postpartum depression (Rundgren et al, 2018), shorter episode duration and more severe depressive symptoms (van Diermen et al, 2018), early depression alleviation (Birkenhager et al, 2019), lower NAA levels in the dACC at baseline (Njau et al, 2017), low genetic risk load (Foo et al, 2019), genetic or epigenetic modifications (Huuhka et al, 2007;Kleimann et al, 2015;Lin et al, 2015), and high baseline serum IL-6 levels (Kruse et al, 2018) and a serum MM-9 profile (Shibasaki et al, 2018) were more likely to benefit ECT recipients. Moreover, the subfield index of hippocampus and neural network plasticity (Abbott et al, 2014;Ota et al, 2015;van Waarde et al, 2015;Redlich et al, 2016;Cao et al, 2018;Nuninga et al, 2019) may provide precise evidence to predict the outcome.…”