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Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)
Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0002-3552-9153
Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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2019 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 5, no 3, article id e46Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Electroconvulsive therapy (ECT) is effective for unipolar depression but relapse and suicide are significant challenges. Lithium could potentially lower these risks, but is used only in a minority of patients.AimsThis study quantifies the effect of lithium on risk of suicide and readmission and identifies factors that are associate with readmission and suicide.

METHOD: This population-based register study used data from the Swedish National Quality Register for ECT and other Swedish national registers. Patients who have received ECT for unipolar depression as in-patients between 2011 and 2016 were followed until death, readmission to hospital or the termination of the study at the end of 2016. Cox regression was used to estimate hazard ratios (HR) of readmission and suicide in adjusted models.

RESULTS: Out of 7350 patients, 56 died by suicide and 4203 were readmitted. Lithium was prescribed to 638 (9%) patients. Mean follow-up was 1.4 years. Lithium was significantly associated with lower risk of suicide (P = 0.014) and readmission (HR 0.84 95% CI 0.75-0.93). The number needed to be treated with lithium to prevent one readmission was 16. In addition, the following factors were statistically associated with suicide: male gender, being a widow, substance use disorder and a history of suicide attempts. Readmission was associated with young age, being divorced or unemployed, comorbid anxiety disorder, nonpsychotic depression, more severe symptoms before ECT, no improvement with ECT, not receiving continuation ECT or antidepressants, usage of antipsychotics, anxiolytics or benzodiazepines, severity of medication resistance and number of previous admissions.

CONCLUSIONS: More patients could benefit from lithium treatment.

Place, publisher, year, edition, pages
Royal College of Psychiatrists , 2019. Vol. 5, no 3, article id e46
Keywords [en]
Depressive disorders, antidepressants, electroconvulsive therapy, inpatient treatment, lithium, suicide
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-75090DOI: 10.1192/bjo.2019.37ISI: 000514364500014PubMedID: 31189487Scopus ID: 2-s2.0-85075709277OAI: oai:DiVA.org:oru-75090DiVA, id: diva2:1337160
Available from: 2019-07-11 Created: 2019-07-11 Last updated: 2023-12-08Bibliographically approved
In thesis
1. Prognostic factors of electroconvulsive therapy for depression
Open this publication in new window or tab >>Prognostic factors of electroconvulsive therapy for depression
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Depression is a severe disorder that can be difficult to treat. One approach to treating depression is electroconvulsive therapy (ECT), whereby electricity is administered through electrodes fastened to the patient’s head. This procedure is effective, however not all patients respond. Moreover, ECT can induce side effects, such as memory problems. In addition, even after achieving remission patients are likely to relapse at a later date. Thus, it is important to optimize ECT in terms of treatment effectiveness while minimizing its side effects. A further crucial issue is to prevent relapses by developing effective follow-up treatments. 

This thesis encapsulates four studies with the following goals: 1) to identify which factors that are associated with the worsening of subjective memory, 2) to identify factors that are associated with remission, 3) to quantify the effect of lithium on relapse after ECT for unipolar depression, 4) to investigate whether the difference in time to relapse between continuation ECT (C-ECT) with medication and medication alone during the first year of treatment changes over 10 years following the end of C-ECT treatment in patients with depression.

The studies were performed using the Swedish national register data. The first two studies used the outcomes of subjective memory worsening and remission respectively. The third and fourth studies used time to relapse as the outcome.

Several factors were associated with the outcomes: in the first, second, and third studies, it was found that older patients were associated with a positive outcome. In both the second and fourth studies, psychotic depression and not having anxiety disorder were associated with positive outcomes. The third study showed that patients who used lithium were less likely to relapse: the hazard ratio with 95% confidence interval among lithium users compared to non-lithium users was 0.84 (0.75–0.93). The fourth study indicated that the beneficial effect of C-ECT and medication compared with medication alone during the first year post-ECT was maintained for several years.

In conclusion, it is important to identify factors that are associated with beneficial treatment, and the studies conducted for this thesis contribute to such knowledge.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 52
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 254
Keywords
Electroconvulsive therapy, unipolar depression, bipolar depression, outcome, memory, relapse, remission, register-based cohort study
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-95780 (URN)9789175294193 (ISBN)
Public defence
2022-02-18, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 13:15 (English)
Opponent
Supervisors
Available from: 2021-12-07 Created: 2021-12-07 Last updated: 2022-02-03Bibliographically approved

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Brus, OleCao, YangNordenskjöld, Axel

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