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Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder: a population based cohort study
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Psychiatric Research Centre.ORCID iD: 0000-0001-7454-3065
Psychiatric Research Centre, Örebro County Council, Örebro, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
Örebro University Hospital, Örebro County Council, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
2013 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 67, no 5, p. 326-333Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of the present study is to investigate the rate of regained occupational functioning among patients treated with electroconvulsive therapy (ECT) for major depression and to define predictors of time to regained occupational functioning.

Methods: A nested cohort study was performed of patients treated by ECT for unipolar major depressive disorder registered in the Quality register for ECT and in the Swedish Social Insurance Agency registry. Predictive values of single clinical variables and their relative importance were tested with Cox regression analysis.

Results: 394 patients were identified. Of those, 266 were on non-permanent sick leave and 128 on disability pension during ECT. Within 1 year post-ECT, 71% of the patients with non-permanent sick leave regained occupational functioning. Factors independently associated with a statistically significant increased time to regained occupational functioning were longer duration of sick leave pre-ECT, milder depression pre-ECT, less complete improvement with ECT, benzodiazepine treatment after ECT and co-morbid substance dependence.

Conclusions: A large proportion of the patients do not return to work within several months post-ECT. Paradoxically, patients with more severe depression pre-ECT had a reduced time to regained occupational functioning, indicating a larger effect in this patients group of the treatment. Moreover, the period with sick leave compensation might be reduced if ECT is initiated within the first 3 months of sick leave.

Clinical implications: Most patients on non-permanent sick leave regain occupational functioning after ECT. However, it usually takes a few months even in symptomatically improved patients.

Place, publisher, year, edition, pages
Oxfordshire, United Kingdom: Taylor & Francis, 2013. Vol. 67, no 5, p. 326-333
National Category
Medical and Health Sciences Psychiatry
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-27586DOI: 10.3109/08039488.2012.745602ISI: 000324776900006PubMedID: 23228156Scopus ID: 2-s2.0-84884507531OAI: oai:DiVA.org:oru-27586DiVA, id: diva2:605827
Note

Journal website: http://informahealthcare.com/loi/psc

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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