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Predictors of time to relapse/recurrence after electroconvulsive therapy in patients with major depressive disorder: a population-based cohort study
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0001-7454-3065
Örebro University, School of Health and Medical Sciences.
2011 (English)In: Depression Research and Treatment, ISSN 2090-1321, E-ISSN 2090-133X, Vol. 2011, p. 470985-Article in journal (Refereed) Published
Abstract [en]

Objective. The aim of the study is to define predictors of relapse/recurrence after electroconvulsive therapy, ECT, for patients with major depressive disorder. Methods. A study of all patients (n = 486) treated by means of ECT for major depressive disorder was performed. The data were derived from a regional quality register in Sweden. Psychiatric hospitalisation or suicide was used as a marker for relapse/recurrence. Results. The relapse/recurrence rate within one year after ECT was 34%. Factors associated with increased risk of relapse/recurrence included comorbid substance dependence and treatment with benzodiazepines or antipsychotics during the follow-up period. Conclusions. Within the first years after ECT, relapses/recurrences leading to hospitalisation or suicide are common. Treatment with lithium might be beneficial, while benzodiazepines, antipsychotics, or continuation ECT does not seem to significantly reduce the risk of relapse/recurrence.

Place, publisher, year, edition, pages
2011. Vol. 2011, p. 470985-
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-27588DOI: 10.1155/2011/470985PubMedID: 22110913OAI: oai:DiVA.org:oru-27588DiVA, id: diva2:605825
Available from: 2013-02-15 Created: 2013-02-15 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Electroconvulsive therapy for depression
Open this publication in new window or tab >>Electroconvulsive therapy for depression
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overarching aims of the thesis were to identify clinical characteristics that predict the outcomes of depressed patients treated inclinical practice by ECT, and to elucidate the effectiveness of continuation ECT at preventing relapses and recurrences.

Methods: The studies included a retrospective chart review, three studies based on a quality register for ECT, and a randomized controlled trial(RCT) examining the effectiveness of continued ECT.

Results: The overall response rate to ECT was 80%. Patients with psychotic depression (89%), older patients (84%), and inpatients (83%) had the highest response rates. Patients with personality disorders (66%) and outpatients (66%) had the lowest response rates. With regard to patients on sick leave, 59%, 71% and 88% of patients regained occupational functioning 6, 12 and 24 months after ECT, respectively. The rate of hospitalisation after ECT was high, with rates of 25%, 34%and 44% 6, 12 and 24 months after ECT, respectively. The relapse rate was higher in patients that were taking benzodiazepines and lower in patients that were taking lithium.

The relapse rate was significantly lower in patients treated with continued ECT in combination with pharmacotherapy (32%) than in those treated with pharmacotherapy alone (61%). This difference was particularly pronounced in medication-resistant patients (31% vs. 85%)

Conclusions: The short-term response rate to ECT is relatively high in all patient subgroups, and is particularly high in older patients, inpatients and patients with severe depression. Patients often regain occupational functioning after ECT; however, this takes a considerably longer time than that required for symptom relief. Nevertheless, the relapse and recurrence rates of patients are high in the years after ECT. Continuation ECT and lithium treatment can be combined with antidepressants to reduce the risk of relapse and recurrence. Further RCTs are required to define the indications for continuation ECT and lithium treatment.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 89
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 85
Keywords
electroconvulsive therapy, mood disorders, depressive disorder, major, bipolar disorder, treatment outcome, recurrence
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-28663 (URN)978-91-7668-932-5 (ISBN)
Public defence
2013-05-24, Bohmanssonsalen Universitetssjukhuset, Södra Grev Rosengatan, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-11 Created: 2013-04-11 Last updated: 2017-10-17Bibliographically approved

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Nordenskjöld, AxelEngström, Ingemar

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