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Predictors of the short-term responder rate of Electroconvulsive therapy in depressive disorders: a population based study
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Psychiatry, University Hospital Örebro, Örebro County, Örebro, Sweden.ORCID iD: 0000-0001-7454-3065
Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; Psychiatric Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2012 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 12, article id 115Article in journal (Refereed) Published
Abstract [en]

Background: The aim of the present study is to investigate the responder rate of Electroconvulsive therapy, ECT, in clinical routine work and to define clinical characteristics predictive of response to ECT. The main hypothesis is that the responder rate of ECT might be lower in clinical routine than in controlled trials.

Methods: This is a population-based study of all patients (N = 990) treated with ECT for depressive disorders, between 2008-2010 in eight hospitals in Sweden. Patients with Clinical Global Impression-Improvement scores of 1 or 2 (much improved) within one week after ECT were considered responders to ECT. The predictive values of single clinical variables were tested by means of chi-squared tests and the relative importance was tested in a logistic regression analysis.

Results: The responder rate was 80.1%. A higher proportion of older patients (>50 years) responded (84.3% vs. 74.2%, p < 0.001). Psychotically depressed patients responded better (88.9% vs. 81.5% for severely depressed and 72.8% for mildly depressed, p < 0.001). There were no significant differences in responder rates between patients suffering from bipolar, first or recurrent major depressive syndromes, or a depressive episode of schizoaffective disorder. Patients with personality disorder had a lower responder rate (66.2% vs. 81.4%, p < 0.001). Also, outpatients had a lower responder rate (66.3%) compared to inpatients (83.4%, p < 0.001). In the logistic regression analysis, inpatient status, psychotic symptoms, absence of schizoaffective disorder and older age were independent factors associated with response to ECT.

Conclusions This study focuses exclusively on the short term responder rate with ECT in clinical practice. Similarly to results from controlled trials a high responder rate is reported. Older patients, more severely ill patients, psychotically ill patients and patients without personality disorders had the highest responder rates. Inpatients may have better outcome with ECT than outpatients.

Place, publisher, year, edition, pages
London, United Kingdom: BioMed Central, 2012. Vol. 12, article id 115
Keywords [en]
Electroconvulsive therapy, major depressive disorder, treatment outcome
National Category
Medical and Health Sciences Psychiatry
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-27587DOI: 10.1186/1471-244X-12-115ISI: 000309711700001PubMedID: 22900754Scopus ID: 2-s2.0-84865055621OAI: oai:DiVA.org:oru-27587DiVA, id: diva2:605826
Available from: 2013-02-15 Created: 2013-02-15 Last updated: 2018-09-06Bibliographically 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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