Toward Targeted ECT

The Journal of Clinical Psychiatry, vol. 82

Abstract

OBJECTIVE: Several clinical variables assumed to be predictive of electroconvulsive therapy (ECT) outcome in major depressive disorder show substantial interrelations. The current study tries to disentangle this interdependence to distill the most important predictors of treatment success to help improve patient-treatment matching. METHODS: We constructed a conceptual framework of interdependence capturing age, episode duration, and treatment resistance, all variables associated with ECT outcome, and the clinical symptoms of what we coin core depression, ie, depression with psychomotor agitation, retardation, psychotic features, or a combination of the three. The model was validated in a sample of 73 patients with a major depressive episode according to DSM-5 treated twice weekly with ECT (August 2015-January 2018) using path analyses, with the size and direction of all direct and indirect paths being estimated using structural equation modeling. Reduction in Montgomery-Asberg Depression Rating Scale (MADRS) scores during treatment was the ECT outcome measure. RESULTS: The baseline presence of psychomotor agitation, retardation, and/or psychotic symptoms strongly correlated with beneficial ECT outcome (z = 0.84 [SE = 0.17]; P < .001), and the association between age and the effect of ECT appears to be mediated by their presence (z = 0.53 [SE = 0.18]; P = .004). There was no direct correlation between age and ECT response (P = .479), but there was for episode duration and ECT outcome (z = -0.38 [SE = 0.08]; P < .001). CONCLUSIONS: ECT is a very effective treatment option for severe depressive disorder, especially for patients suffering from severe depression characterized by the presence of psychomotor agitation, psychomotor retardation, psychotic symptoms, or a combination of these 3 features, with the chance of a beneficial outcome being reduced in patients with a longer episode duration. Age may heretofore have been given too much weight in ECT decision making. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02562846.

Authors 9

1. Linda van Diermen

   University of Antwerp · Bethanien Krankenhaus Moers

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

   PC Bethanië, Andreas Vesaliuslaan 39, 2980 Zoersel, Belgium. linda.van.diermen@emmaus.be

   Psychiatric Center Bethanië, Zoersel, Belgium

   University Psychiatric Center (UPC) Duffel, Duffel, Belgium

2. Ervin Poljac

   University of Antwerp

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

   University Psychiatric Center (UPC) Duffel, Duffel, Belgium

3. Roos C. van der Mast Aachen Department of Psychiatry, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands

    Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands;

4. Kristiaan Plasmans

   Bethanien Krankenhaus Moers

   Affiliation as printed

   Psychiatric Center Bethanië, Zoersel, Belgium

5. Seline van den Ameele

   Vrije Universiteit Brussel · University of Antwerp · Universitair Ziekenhuis Brussel

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

   Department of Psychiatry, University Hospital Brussels (UZ-VUB), Brussels, Belgium

   University Psychiatric Center (UPC) Duffel, Duffel, Belgium

6. Willemijn T.C.J. Heijnen

   Erasmus MC

   Affiliation as printed

   Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

   Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

7. Tom K. Birkenhäger

   Erasmus MC

   Affiliation as printed

   Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

   Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

8. Didier L. Schrijvers

   University of Antwerp

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

   University Psychiatric Center (UPC) Duffel, Duffel, Belgium

9. Astrid Mariska Kamperman

   Erasmus MC · Erasmus University Rotterdam

   Affiliation as printed

   Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands

   Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands