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Response to electroconvulsive therapy in treatment-resistant depression: nationwide observational follow-up study
Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden.
Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden.
Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden.
Department of Medical Sciences, Psychiatry, Uppsala University, Sweden.
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2023 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 9, no 2, article id e35Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Previous studies have not investigated response rates after electroconvulsive therapy (ECT) in patients with non-psychotic treatment-resistant depression (TRD).

AIMS: To assess and compare the response rate of ECT for patients with TRD and non-TRD, in a large and clinically representative patient sample.

METHOD: Patients aged ≥18 years, who were treated for a unipolar, non-psychotic depressive episode with at least one ECT session as part of a first-time, index ECT series between 1 January 2011 and 31 December 2017 were included from the Swedish National Quality Register for ECT. Patients who had initiated a third consecutive trial of antidepressants or add-on medications before start of ECT were classified as having TRD. Patients not meeting criteria for TRD were classified as non-TRD. The main outcome was response to ECT according to the Clinical Global Impressions - Improvement Scale (CGI-I), scored as 1 or 2 ('very much' or 'much improved' after ECT, respectively). Logistic regression was used to compare outcome measures between TRD and non-TRD, adjusting for potential confounders.

RESULTS: A total of 4244 patients were included. Of these, 1121 patients had TRD and 3123 patients had non-TRD. The CGI-I response rate was 65.9% in the TRD group compared with 75.9% in the non-TRD group (adjusted odds ratio 0.64, 95% CI 0.54-0.75). Older age and more severe depression were predictors of response in patients with TRD.

CONCLUSIONS: A clear majority of patients with TRD, as well as patients with non-TRD, responded to ECT, although the response rate was somewhat lower for TRD.

Place, publisher, year, edition, pages
Royal College of Psychiatrists , 2023. Vol. 9, no 2, article id e35
Keywords [en]
Depressive disorders, antidepressants, electroconvulsive therapy, epidemiology, outcome studies
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-104176DOI: 10.1192/bjo.2023.5ISI: 000934333300001PubMedID: 36786152Scopus ID: 2-s2.0-85148506800OAI: oai:DiVA.org:oru-104176DiVA, id: diva2:1736984
Funder
Swedish Research Council, 2016-02362Region StockholmKarolinska Institute, 5-63/2015
Note

Funding agencyies:

Stiftelsen Professor Bror Gadelius Minnesfond

Johnson & Johnson USA Janssen Biotech Inc 5-63/2015

Available from: 2023-02-15 Created: 2023-02-15 Last updated: 2023-03-08Bibliographically approved

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Nordenskjöld, Axel

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