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Tornhamre, E., Hammar, Å., Nordanskog, P. & Nordenskjöld, A. (2025). Who is at risk of long-term subjective memory impairment after electroconvulsive therapy?. Journal of Affective Disorders, 372, 324-332
Open this publication in new window or tab >>Who is at risk of long-term subjective memory impairment after electroconvulsive therapy?
2025 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 372, p. 324-332Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for depression with potential transient cognitive side effects. However, subjective memory impairment can extend over a long period after ECT.

OBJECTIVES: This study aimed to assess potential risk factors for long-term subjective memory impairment 6 months after ECT and to explore if the associations are mediated by depressive symptoms.

METHODS: This registry-based study used the Swedish National Quality Register for ECT and other national registers. Long-term subjective memory worsening was defined as a minimum 2-step worsening on the memory item from the comprehensive psychopathological rating scale (CPRS-M) from before ECT to 6 months after ECT. Changes on the scale were also analyzed in continuous models. Statistical methods used were logistic regression and linear regression analyses in univariable and multivariable models.

RESULTS: The study population consisted of 1498 patients. Subjective memory worsening occurred in 25.2 % of the population. Long-term subjective memory worsening was associated with more depressive symptoms and lower education levels. No association could be found related to ECT technical factors. The associations between age and psychiatric comorbidities with subjective memory worsening were mediated by depressive symptoms.

CONCLUSION: Patients can be informed that depressive symptoms are one of the biggest contributing factors to long-term subjective memory impairment after ECT. A successful treatment is therefore important to minimize the long-term experience of memory deficits. The number of sessions or ECT technical factors do not seem to be associated with long-term subjective memory impairment.

Place, publisher, year, edition, pages
Elsevier, 2025
Keywords
Depression, Electroconvulsive therapy, Long-term, Memory, Risk factors
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-117711 (URN)10.1016/j.jad.2024.12.028 (DOI)001386560900001 ()39644929 (PubMedID)=2-s2.0-85211981887 (Scopus ID)
Funder
Region Örebro CountyNyckelfonden
Available from: 2024-12-09 Created: 2024-12-09 Last updated: 2025-01-15Bibliographically approved
Al-Wandi, A., Landén, M. & Nordenskjöld, A. (2024). Antipsychotics in the maintenance phase for psychotic depression. Acta Psychiatrica Scandinavica, 149(1), 6-17
Open this publication in new window or tab >>Antipsychotics in the maintenance phase for psychotic depression
2024 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 149, no 1, p. 6-17Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: This study aimed to associate antidepressants with versus without antipsychotics with readmission and suicide in patients with psychotic unipolar depression.

METHODS: Swedish national registers were used to identify inpatients with psychotic unipolar depression, treated 2007-2016. The participants collected antidepressants with or without antipsychotics from a pharmacy within 14 days after discharge and were followed up for 2 years. The primary outcome was hospital readmission due to any psychiatric disorder, suicide attempt, or completed suicide. Cox regression was used to analyze the data, which were adjusted for sex, age, prior admissions, comorbidity, electroconvulsive therapy, and other pharmacological treatments.

RESULTS: We identified 4391 patients, of which 2972 were in the antidepressant + antipsychotic combination therapy group, and 1419 were in the antidepressant monotherapy group. After 2 years, 42.3% and 36.6% of patients were readmitted or committed suicide in the combination therapy and monotherapy group, respectively. Monotherapy was significantly associated with a lower risk of reaching the outcome in the main analysis (hazard ratio = 0.86; 95% confidence interval: 0.77-0.95). The results went in the same direction in all sensitivity analyses.

CONCLUSION: Our findings do not indicate any advantage of adding antipsychotics as adjunctive to antidepressants as maintenance treatment. Considering the wide use, known side effects, and the current lack of evidence supporting the benefit, further studies on the effect of antipsychotics in the maintenance phase of psychotic unipolar depression are urgently warranted.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
Antidepressants, antipsychotics, psychotic depression, readmission, relapse
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-109607 (URN)10.1111/acps.13628 (DOI)001099887800001 ()37932158 (PubMedID)2-s2.0-85176095605 (Scopus ID)
Funder
Region Örebro County
Available from: 2023-11-07 Created: 2023-11-07 Last updated: 2024-01-22Bibliographically approved
Popiolek, K., Arnison, T., Bejerot, S., Fall, K., Landén, M. & Nordenskjöld, A. (2024). Association between electroconvulsive therapy and time to readmission after a manic episode. Acta Psychiatrica Scandinavica, 150(1), 22-34
Open this publication in new window or tab >>Association between electroconvulsive therapy and time to readmission after a manic episode
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2024 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 150, no 1, p. 22-34Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The majority of patients hospitalized for treatment of a manic episode are readmitted within 2 years despite maintenance treatment. Electroconvulsive therapy (ECT) has been associated with lower rehospitalization rates in some psychiatric conditions, but its association with readmission after a manic episode has not been investigated. Therefore, the aim of this study was to determine whether the time to readmission in patients with mania treated with ECT was longer than in patients not treated with ECT and whether there were subgroups of patients that benefited more.

METHODS: This was a nationwide register-based, observational study. All patients diagnosed with bipolar disorder, manic episode, admitted to any hospital in Sweden between 2012 and 2021 were included. Patients contributed data to the study for every admission. All admissions were followed up until psychiatric readmission, death, or the end of the study (December 31, 2021). Association between ECT and time to readmission was analyzed. A paired samples model was performed for 377 patients with at least two admissions for mania, treated with ECT at one admission and without ECT at the other admission. Times to readmission were analyzed.

RESULTS: A total of 12,337 admissions were included; mean (SD) age 47.7 (17.2), 5443 (44.1%) men. Readmission rate within 1 year was 54.6%. ECT was administered in 902 (7.3%) admissions. Within 30 days after admission, 182 out of 894 (20.4%) patients treated with ECT versus 2105 out of 11,305 (18.6%) patients treated without ECT were readmitted. There was no association between ECT and time to readmission (aHR 1.00, 95% CI 0.86-1.16, p = 0.992) in the model with all admissions. The paired samples model included 754 admissions (377 patients), mean (SD) age during admission without ECT was 45.6 (16.5), and with ECT 46.6 (16.4), 147 (39.0%) were men. In that model, readmission rate within 30 days for treatment with ECT was 19.0%, and for treatments without ECT, 24.1% (aHR 0.75, 95% CI 0.55-1.02, p = 0.067).

CONCLUSION: Readmission rates after inpatient treatment of mania were high. ECT was not significantly associated with longer time to readmission, but there was a trend toward a protective effect of ECT when admissions with and without ECT were compared within the same patients.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
Bipolar disorder, electroconvulsive therapy, mania, readmission, rehospitalization
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-113093 (URN)10.1111/acps.13689 (DOI)001199821200001 ()38604233 (PubMedID)2-s2.0-85190443565 (Scopus ID)
Funder
Region Örebro County, OLL-972634NyckelfondenSwedish Research Council, 2022-01643The Swedish Brain Foundation, FO2022-0217
Available from: 2024-04-12 Created: 2024-04-12 Last updated: 2024-06-05Bibliographically approved
Ernstsson, O., Heintz, E., Nordenskjöld, A., Johnson, J. A., Korkmaz, S. & Zethraeus, N. (2024). Association between pulse width and health-related quality of life after electroconvulsive therapy in patients with unipolar or bipolar depression: an observational register-based study. Nordic Journal of Psychiatry, 78(2), 137-145
Open this publication in new window or tab >>Association between pulse width and health-related quality of life after electroconvulsive therapy in patients with unipolar or bipolar depression: an observational register-based study
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2024 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 78, no 2, p. 137-145Article in journal (Refereed) Published
Abstract [en]

AIMS: To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression.

METHODS: This was an observational register study using data from the Swedish National Quality Registry for ECT (2011-2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before and after ECT. Multiple linear regressions were performed to investigate the association between pulse width (<0.5 ms; 0.5 ms; >0.5 ms) and HRQoL (EQ-5D-3L index; EQ VAS) one week after ECT (primary outcome) and six months after ECT (secondary outcome).

RESULTS: The sample included 5,046 patients with unipolar (82%) or bipolar (18%) depression. At first ECT session, 741 patients (14.7%) had pulse width <0.5 ms, 3,639 (72.1%) had 0.5 ms, and 666 (13.2%) had >0.5 ms. There were no statistically significant associations between pulse width and HRQoL one week after ECT. In the subsample of patients with an EQ-5D index recorded six months after ECT (n = 730), patients receiving 0.5 ms had significantly lower HRQoL (-0.089) compared to <0.5 ms, after adjusting for demographic and clinical characteristics (p = .011). The corresponding analysis for EQ VAS did not show any statistically significant associations.

CONCLUSION: No robust associations were observed between pulse width and HRQoL after ECT. On average, significant improvements in HRQoL were observed one week and six months after ECT for patients with unipolar or bipolar disease, independent of the pulse width received.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Depressive disorders, electroconvulsive therapy, eq-5d, pulse width, quality of life
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-110371 (URN)10.1080/08039488.2023.2289915 (DOI)001124132000001 ()38079191 (PubMedID)2-s2.0-85180181665 (Scopus ID)
Funder
Region Stockholm
Note

Funding Agencies:

Region Stockholm

uroQol Research Foundation

Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2024-03-22Bibliographically approved
Sigström, R., Göteson, A., Joas, E., Pålsson, E., Liberg, B., Nordenskjöld, A., . . . Landén, M. (2024). Blood biomarkers of neuronal injury and astrocytic reactivity in electroconvulsive therapy. Molecular Psychiatry
Open this publication in new window or tab >>Blood biomarkers of neuronal injury and astrocytic reactivity in electroconvulsive therapy
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2024 (English)In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578Article in journal (Refereed) Epub ahead of print
Abstract [en]

Despite electroconvulsive therapy (ECT) being recognized as an effective treatment for major depressive episodes (MDE), its application is subject to controversy due to concerns over cognitive side effects. The pathophysiology of these side effects is not well understood. Here, we examined the effects of ECT on blood-based biomarkers of neuronal injury and astrocytic reactivity. Participants with a major depressive episode (N = 99) underwent acute ECT. Blood was sampled just before (T0) and 30 min after (T1) the first ECT session, as well as just before the sixth session (T2; 48-72 h after the fifth session). Age- and sex-matched controls (N = 99) were recruited from the general population. Serum concentrations of neurofilament light chain (NfL), total tau protein, and glial fibrillary acidic protein (GFAP) were measured with ultrasensitive single-molecule array assays. Utilizing generalized least squares regression, we compared baseline (T0) biomarker concentrations against those of our control group, and calculated the shifts in serum biomarker concentrations from baseline to immediately post-first ECT session (T1), and prior to the sixth session (T2). Baseline analysis revealed that serum levels of NfL (p < 0.001) and tau (p = 0.036) were significantly elevated in ECT recipients compared with controls, whereas GFAP levels showed no significant difference. Relative to T0, serum NfL concentration neither changed at T1 (mean change 3.1%, 95%CI -0.5% to 6.7%, p = 0.088) nor at T2 (mean change -3.2%, 95%CI -7.6% to 1.5%, p = 0.18). Similarly, no change in total tau was observed (mean change 3.7%, 95%CI -11.6% to 21.7%, p = 0.65). GFAP increased from T0 to T1 (mean change 20.3%, 95%CI 14.6 to 26.3%, p < 0.001), but not from T0 to T2 (mean change -0.7%, 95%CI -5.8% to 4.8%, p = 0.82). In conclusion, our findings suggest that ECT induces a temporary increase in serum GFAP, possibly reflecting transient astrocytic activation. Importantly, we observed no indicators of neuronal damage or long-term elevation in any assessed biomarker.

Place, publisher, year, edition, pages
Springer Nature, 2024
National Category
Neurosciences Psychiatry
Identifiers
urn:nbn:se:oru:diva-116535 (URN)10.1038/s41380-024-02774-4 (DOI)001328544200001 ()39363047 (PubMedID)2-s2.0-85205595687 (Scopus ID)
Funder
University of GothenburgSwedish Foundation for Strategic Research, KF10-0039Swedish Research Council, 2022-01643; 2022-01018; 2019-02397; 2017-00915; 2022-00732Fredrik och Ingrid Thurings Stiftelse, 2019-00478Wenner-Gren Foundations, SSv2019-0008EU, Horizon Europe, 101053962Stiftelsen Gamla TjänarinnorThe Swedish Brain Foundation, FO2022-0270; FO2017-0243; ALZ2022-0006EU, Horizon 2020, 860197Alzheimerfonden, AF-930351; AF-939721; AF-968270
Note

This work was supported by grants from the Swedish Foundation for Strategic Research (KF10-0039; ML), the Swedish Research Council (2022-01643; ML), Thurings stiftelse (2019-00478; RS), and by the Swedish state under the agreement between the Swedish Government and the county councils, the ALF-agreement (ALFGBG-965444; ML). RS was supported by a grant from the Swedish state under the agreement between the Swedish Government and the county councils, the ALF-agreement (ALFGBG-942684). ML was supported by a grant from the Wenner-Gren foundation (SSv2019-0008). HZ is a Wallenberg Scholar supported by grants from the Swedish Research Council (2022-01018 and 2019-02397), the European Union's Horizon Europe research and innovation program under grant agreement No 101053962, the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (ALFGBG-71320), the Alzheimer Drug Discovery Foundation (ADDF), USA (201809-2016862), the AD Strategic Fund and the Alzheimer's Association (ADSF-21-831376-C, ADSF-21-831381-C, and ADSF-21-831377-C), the Bluefield Project, the Olav Thon Foundation, the Erling-Persson Family Foundation, Stiftelsen for Gamla Tjanarinnor, Hjarnfonden, Sweden (FO2022-0270), the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 860197 (MIRIADE), the European Union Joint Program-Neurodegenerative Disease Research (JPND2021-00694), and the UK Dementia Research Institute at UCL (UKDRI-1003). KB is supported by the Swedish Research Council (2017-00915 and 2022-00732), the Swedish Alzheimer Foundation (AF-930351, AF-939721 and AF-968270), Hjarnfonden, Sweden (FO2017-0243 and ALZ2022-0006), the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (ALFGBG-715986 and ALFGBG-965240), the European Union Joint Program for Neurodegenerative Disorders (JPND2019-466-236), the Alzheimer's Association 2021 Zenith Award (ZEN-21-848495), and the Alzheimer's Association 2022-2025 Grant (SG-23-1038904 QC). We thank the study participants for their contribution to this research. We also thank the staff at ECT units throughout Sweden and the Swedish National Quality register for ECT (Q-ECT) for collection and sharing of data. A special thanks to the PREFECT project manager Anders Jureus, the PREFECT research nurses Marie Lundin, Birgitta Ohlander, Milka Krestelica, Radja Dawoud, Martina Wennberg, and the PREFECT data manager Bozenna Illiadou. The BBMRI.se and KI Biobank at Karolinska Institutet are acknowledged for professional biobank service.Open access funding provided by University of Gothenburg.

Available from: 2024-10-04 Created: 2024-10-04 Last updated: 2025-01-20Bibliographically approved
Al-Wandi, A., Landén, M. & Nordenskjöld, A. (2024). Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression. Acta Psychiatrica Scandinavica, 150(3), 148-159
Open this publication in new window or tab >>Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression
2024 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 150, no 3, p. 148-159Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To determine whether the rates of readmissions and suicide vary in psychotic unipolar depression based on whether patients receive maintenance electroconvulsive therapy (M-ECT) following the initial series of ECT, and to examine if there is an age-dependent association.

METHODS: We used Swedish national registries to identify hospitalized patients with psychotic unipolar depression, treated 2008-2019 who received ECT during their hospital stay. The patients who received subsequent M-ECT within 14 days after discharge were compared with those who did not. The primary composite outcome was time to readmission due to a psychiatric disorder, suicide attempt, or suicide within 2 years from discharge. Data were analyzed using Cox regression adjusted for previous psychiatric admissions, age, sex, comorbidity, and pharmacological treatment. We also conducted a within-individual analysis using the sign-test, with patients having ≥1 hospital episode followed by M-ECT and ≥1 hospital episode without M-ECT.

RESULTS: A total of 1873 patients were included, of which 130 received M-ECT. There was no statistically significant group difference regarding the primary outcome in the whole sample. However, when stratified by age, there was a significant difference in favor of M-ECT for patients >65 years (adjusted hazard ratio 0.55, 95% confidence interval 0.35-0.87). The within-individual analysis, including 46 patients, significantly favored M-ECT.

CONCLUSION: M-ECT was not associated with a differential risk of the composite of readmission and suicide in psychotic depression. Among patients >65 years, M-ECT was significantly associated with a decreased risk of the outcome. The possibility of residual confounding cannot be excluded.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
Electroconvulsive therapy, maintenance, psychotic depression, readmission, relapse
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-113970 (URN)10.1111/acps.13711 (DOI)001233263200001 ()38804530 (PubMedID)2-s2.0-85194877473 (Scopus ID)
Funder
Region Örebro County
Available from: 2024-05-29 Created: 2024-05-29 Last updated: 2024-09-02Bibliographically approved
Strandberg, P., Nordenskjöld, A., Bodén, R., Ekman, C. J., Lundberg, J. & Popiolek, K. (2024). Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode: A Register-Based Study. Journal of ECT, 40(2), 88-95
Open this publication in new window or tab >>Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode: A Register-Based Study
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2024 (English)In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 40, no 2, p. 88-95Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in treating depression. Although rTMS induces fewer adverse effects, its effectiveness relative to ECT is not well established. The aim of this study was to investigate the treatment outcomes of ECT and rTMS in patients who have received both interventions.

METHODS: This was a register-based observational crossover study in patients with depression who had undergone ECT and rTMS in Sweden between 2012 and 2021. Primary outcome was reduction in the Montgomery-Åsberg Depression Rating Scale-Self-report (MADRS-S) score. Secondary outcome was response defined as a 50% or greater decrease in the MADRS-S score. Subgroup analyses were performed to identify factors that predicted differential responses between rTMS and ECT. Continuous and categorical variables were analyzed using paired-samples t tests and McNemar tests, respectively.

RESULTS: In total, 138 patients across 19 hospitals were included. The MADRS-S score after ECT and rTMS was reduced by 15.0 and 5.6 (P = 0.0001) points, respectively. Response rates to ECT and rTMS were 38% and 15% (P = 0.0001), respectively. Electroconvulsive therapy was superior across all subgroups classified according to age and severity of depression.

CONCLUSIONS: Our results suggest that ECT is more effective than rTMS in treating depression among patients who have received both interventions. Age and baseline depression severity did not predict who would similarly benefit from rTMS and ECT.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024
Keywords
electroconvulsive therapy, repetitive transcranial magnetic stimulation, major depressive disorder
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-110020 (URN)10.1097/YCT.0000000000000971 (DOI)001234685900007 ()38048154 (PubMedID)2-s2.0-85192231990 (Scopus ID)
Funder
NyckelfondenRegion Örebro County
Available from: 2023-12-05 Created: 2023-12-05 Last updated: 2024-06-13Bibliographically approved
Popiolek, K., Arnison, T., Boden, R., Ekman, C. J., Lundberg, J., Strandberg, P. & Nordenskjöld, A. (2024). Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode: A Register-Based Study [Letter to the editor]. Journal of ECT, 40(2), 140-141
Open this publication in new window or tab >>Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode: A Register-Based Study
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2024 (English)In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 40, no 2, p. 140-141Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-113978 (URN)10.1097/yct.0000000000001005 (DOI)001234685900008 ()38456234 (PubMedID)2-s2.0-85194976174 (Scopus ID)
Funder
Region Örebro CountyNyckelfonden
Available from: 2024-05-29 Created: 2024-05-29 Last updated: 2025-02-04Bibliographically approved
Ekstrand, J., Takamiya, A., Nordenskjöld, A., Kirov, G., Sienaert, P., Kellner, C. & Movahed Rad, P. (2024). Ketamine or ECT? What have we learned from the KetECT and ELEKT-D trials?. International Journal of Neuropsychopharmacology, 27(1), Article ID pyad065.
Open this publication in new window or tab >>Ketamine or ECT? What have we learned from the KetECT and ELEKT-D trials?
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2024 (English)In: International Journal of Neuropsychopharmacology, ISSN 1461-1457, E-ISSN 1469-5111, Vol. 27, no 1, article id pyad065Article in journal (Refereed) Published
Abstract [en]

Two recent clinical trials, KetECT and ELEKT-D, compared the effectiveness of ketamine and electroconvulsive therapy (ECT) for major depressive disorder. Notably, these trials reported marked differences in ECT's clinical outcomes of, with remission rates of 63% for KetECT and a strikingly lower rate of 22% for ELEKT-D, while the remission rates for ketamine were 46% and 38%, respectively. Considering that the primary objective of both trials was to compare the standard treatment (ECT) with an experimental intervention (ketamine), it is crucial to highlight the pronounced disparities in ECT's clinical outcomes. This article offers a comprehensive comparison of these trials while also exploring how patient characteristics, treatment protocols, and study designs may contribute to such pronounced outcome discrepancies. These differences highlight the heterogeneous nature of depression and underscore the need for personalized treatments. These studies also provide valuable insights into identifying the most suitable candidates for ketamine and ECT.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
Clinical trials, Electroconvulsive therapy, Major depressive disorder, Racemic Ketamine
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-110457 (URN)10.1093/ijnp/pyad065 (DOI)001153591700001 ()38114073 (PubMedID)2-s2.0-85184037882 (Scopus ID)
Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2024-02-14Bibliographically approved
Brus, O., Cao, Y., Carlborg, A., Engström, I., von Knorring, L. & Nordenskjöld, A. (2024). Long-Term Effect of Maintenance Electroconvulsive Therapy in Patients With Depression-Data From a Small Randomized Controlled Trial. Journal of ECT, 40(3), 169-172
Open this publication in new window or tab >>Long-Term Effect of Maintenance Electroconvulsive Therapy in Patients With Depression-Data From a Small Randomized Controlled Trial
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2024 (English)In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 40, no 3, p. 169-172Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: This study aimed to compare the long-term effects of maintenance electroconvulsive therapy (M-ECT) with medication and medication only in patients with depression.

METHODS: A randomized controlled trial of 1 year of M-ECT with medication or medication only investigated relapse/recurrence among 56 patients in remission after electroconvulsive therapy (ECT) for depression was conducted. The results of the first year are published already and showed a significant advantage of M-ECT with medication.The current study was a long-term follow-up. When the randomized treatment allocation ended, medication was continued in both groups but M-ECT was terminated. Patients were followed for up to 10 years via Swedish national registers until the study endpoint of a new psychiatric diagnosis as an inpatient, suicide, suspected suicide, or death of another cause. Time to relapse was compared between the M-ECT with medication group and the medication-only group using Kaplan-Meier estimates.

RESULTS: The median follow-up time was 6.5 years for the M-ECT and medication group and 3.1 years for the medication-only group. One year after randomization 22 patients remained in the M-ECT and medication group, and 14 patients remained in the medication-only group. Relapse patterns between the treatment groups after the completion of M-ECT seemed to be similar according to visual inspection.

CONCLUSIONS: This long-term follow-up study suggests that most of the benefit achieved during the treatment period with M-ECT is maintained over several years, but the small sample size, with accompanying large statistical imprecision, makes the results uncertain. More long-term studies of M-ECT are required.Trial registration: ClinicalTrials.gov identifier: NCT00627887.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024
Keywords
electroconvulsive therapy, depression, depressive disorder, major
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-111028 (URN)10.1097/YCT.0000000000000983 (DOI)001339504100012 ()38232249 (PubMedID)2-s2.0-85202730041 (Scopus ID)
Funder
Region Örebro County
Note

Uppsala-Örebro Regional Research Council and Research Committee of Örebro County Council, Örebro, Sweden, supported the research.

Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-11-05Bibliographically approved
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