Electroconvulsive therapy effective treatment option for severe depressive disorder

Electroconvulsive therapy was a significantly effective treatment option for severe depressive disorder, according to study results published in Journal of Clinical Psychiatry.

“In our 2018 meta-analysis of clinical predictors, we concluded that ECT was most successful in older patients and those with more severe depression and psychotic features,” Linda van Diermen, MD, PhD, of the University Psychiatric Center in Belgium, and colleagues wrote. “We recently reported that the presence of psychomotor symptoms, such as retardation (noticeable manifestations of slowing) and agitation (increased activity) also appears to be closely related to ECT outcome in depression: the patients with evident psychomotor symptoms were 4.9 times more likely to respond to ECT than those not presenting with such symptoms.”

In the current study, the researchers sought to identify the most important predictors of successful ECT treatment for this patient population. They created a conceptual framework of interdependence with variables linked to ECT outcome, including age, episode duration and treatment resistance, as well as the clinical symptoms of what they termed “core depression,” or depression with psychomotor agitation, retardation, psychotic features or a combination of these three. They used path analyses, with the size and direction of all direct and indirect paths being estimated using structural equation modeling, to validate the model among a sample of 73 individuals with a major depressive episode per DSM-5 criteria who were treated twice weekly with ECT. The ECT outcome measure was reduction in Montgomery-Asberg Depression Rating Scale (MADRS) scores during treatment.

Results showed a strong correlation between baseline presence of psychomotor agitation, retardation and/or psychotic symptoms with beneficial ECT outcome. The link between age and ECT effect appeared mediated by the presence of these psychomotor or psychotic symptoms. Although there was no direct association between age and ECT response, the researchers did note one for episode duration and ECT outcome.

“In these patients, we suggest to first confirm the diagnosis of depression and to look for comorbidity that may interfere with the response to ECT,” van Diermen and colleagues wrote. “Our finding that age exerts merely an indirect influence on ECT outcome is interesting as it suggests that age alone is not a relevant factor when considering ECT.”