Starting ECT earlier to treat MDD, bipolar disorder may improve clinical outcomes

Introducing electroconvulsive therapy earlier in a treatment course for major depressive disorder or bipolar disorder may lead to improvements in clinical outcomes, according to a study published in the Journal of Clinical Psychiatry.

“Major depressive disorder is a highly prevalent and debilitation psychiatric disorder that is a leading cause of disability worldwide,” Kazuki Nakajima, MD, of the department of neuropsychiatry at Keio University School of Medicine in Tokyo, and colleagues wrote. “Although ECT is the most effective and safe treatment for severe depression, it requires frequent general anesthesia and is associated with often transient cognitive side effects.”

Nakajima and colleagues sought to build a clinically useful prediction model for ECT remission based solely on clinical information and to identify influential features in the prediction model.

They conducted a retrospective chart review of 177 individuals with either unipolar MDD or bipolar disorder, registered between April 2012 and March 2019 and diagnosed via DSM-IV-TR criteria, who received ECT two to three times per week at Keio University Hospital.

All participants were given ECT under intravenous general anesthesia along with a muscle relaxer, then given a higher intensity when seizure duration lasted fewer than 20 seconds. Clinical characteristics were used as candidate features. Baseline seizure severity and ECT outcomes were measures with the seven-point Clinical Global Impressions-Severity of Illness scale and four-point clinical note CGI-Improvement scale. A light gradient boosting machine was used for prediction, and five-fold cross-validation was performed to validate the prediction model.

Results showed that remission rate was 63%. The researchers’ model predicted individual patient outcomes with 71% accuracy (sensitivity, 86%; specificity, 46%). A shorter duration of the current episodes, lower baseline severity, higher dose of antidepressant medications before ECT, and lower BMI were identified as important features for predicting remission following ECT.

“Based on the set of features identified in the current study, introducing ECT earlier in the treatment course may lead to improvements in clinical outcomes,” Nakajima and colleagues wrote.