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Unmasking Patient Diversity: Exploring Cognitive and Antidepressive Effects of Electroconvulsive Therapy
NKS Olaviken gerontopsychiatric hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Psychiatry, Haukeland University Hospital, Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Psychiatry, Haukeland University Hospital, Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Norway.
Örebro University, School of Medical Sciences. The University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0001-7454-3065
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2024 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 67, no 1, article id e12Article in journal (Refereed) Published
Abstract [en]

Background: Electroconvulsive therapy (ECT) is an established treatment for depression, but more data on effectiveness and safety in clinical practice is needed. The aim of this register-based study was to investigate short-term effectiveness and cognitive safety after ECT, evaluated by clinicians and patients. Secondary, we investigated predictors for remission and cognitive decline.

Methods: The study included 392 patients from the Regional Register for Neurostimulation Treatment in Western Norway. Depressive symptoms and cognitive function were assessed with Montgomery-angstrom sberg Depression Rating Scale and Mini-Mental State Examination (clinician-rated) and Beck Depression Inventory and Everyday Memory Questionnaire (patient-rated). Assessments were done prior to ECT-series and a mean of 1.7 days after (range 6 days before and 12 days after) end of ECT-series. Paired samples t-tests were extended by detailed, clinically relevant subgroups. Predictors were examined using logistic regression.

Results: Clinician- and patient-rated remission rates were 49.5 and 41.0%, respectively. There was a large reduction in depressive symptoms and a small improvement in cognition after ECT, but we also identified subgroups with non-response of ECT in combination with cognitive decline (4.6% clinician-rated, 15.7% patient-rated). Positive predictors for patient- and clinician-rated remission were increasing age, shorter duration of depressive episode, and psychotic features. Antipsychotic medication at the commencement of treatment and previous ECT-treatment gave higher odds of clinician-rated remission, whereas higher pretreatment subjective depression level was associated with lower odds for patient-rated remission. Clinician-rated cognitive decline was predicted by higher pretreatment MMSE scores, whereas psychotic features, increasing age, and greater pretreatment subjective memory concerns were associated with lower odds for patient-rated cognitive decline.

Conclusions: Our study supports ECT as an effective and safe treatment, although subgroups have a less favorable outcome. ECT should be considered at an early stage for older patients suffering from depression with psychotic features. Providing comprehensive and balanced information from clinicians and patients perspectives on effects and side effects, may assist in a joint consent process.

Place, publisher, year, edition, pages
Cambridge University Press, 2024. Vol. 67, no 1, article id e12
Keywords [en]
Psychiatry, Depression, Neurostimulation treatment, Electroconvulsive therapy, ECT effectiveness, ECT cognitive outcomes
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-110699DOI: 10.1192/j.eurpsy.2024.1ISI: 001160538800001PubMedID: 38214065Scopus ID: 2-s2.0-85183691531OAI: oai:DiVA.org:oru-110699DiVA, id: diva2:1827127
Note

The study was supported by Norwegian Health West (project F-12169).

Available from: 2024-01-12 Created: 2024-01-12 Last updated: 2025-01-20Bibliographically approved

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