Abstract
BackgroundNaturalistic studies can be useful tools to understand how an intervention works in the real clinical practice. This study aims to investigate the outcomes in a naturalistically treated depressed inpatients cohort, who were referred, or not, to unilateral ECT.MethodsDepressed adults according to MINI admitted in a psychiatric unit were divided in unilateral ECT treated and non-ECT treated. Main outcomes were: depression improvement in Hamilton Rating Scale for Depression (HDRS-17) scores; response (HDRS-17 improvement ≥50 %); remission (HDRS-17 score ≤7); length of hospitalization.ResultsForty-three patients were included in unilateral ECT group and 104 in non-ECT group. No differences of psychotic symptoms, melancholic features or past maniac episode were found between groups. Unilateral ECT group had a mean HDRS-17 score higher than non-ECT group at admission (ECT: 25.05 ± 1.03; non-ECT: 21.61 ± 0.69; p = 0.001), but no significant difference was found at discharge (ECT: 7.70 ± 0.81; non-ECT: 7.40 ± 0.51; p = 0.75). Unilateral ECT group had a larger HDRS-17 score reduction during treatment (ECT: 18.24 ± 1.18; non-ECT:14.20 ± 0.76; p = 0.004). There were no significant differences in response and remission rates between groups. Unilateral ECT group had longer mean duration of hospitalization in days (ECT: 35.48 ± 2.48; non-ECT: 24.57 ± 1.50; p < 0.001), but there were no difference in mean time of treatment (ECT group:27.66 ± 1.95; non-ECT: 24.57 ± 1.50; p = 0.25).ConclusionsUnilateral high-dose ECT is still a useful treatment option, in the real world clinical practice, to reduce the intensity of depressive symptoms in highly depressed inpatients.
Highlights
Naturalistic studies can be useful tools to understand how an intervention works in the real clinical practice
The objective of this study is to evaluate the outcomes of severely depressed inpatients who were referred to receive high-dose unilateral Electroconvulsive therapy (ECT) when compared to patients who were not referred to such treatment
This happened due to a longer mean duration of hospitalization and a greater reduction of depressive symptoms, because the ability to reduce the score in ECT patients was the greatest
Summary
Naturalistic studies can be useful tools to understand how an intervention works in the real clinical practice. Extrapolating the findings of randomized clinical trials (RCTs) and meta-analyses to clinical practice is still a challenge for clinicians, especially when analyzing patients with high incidence of somatic and psychiatric comorbidities. When an experienced clinician indicates ECT for a patient, he or she may do so based on evidence regarding a particular group of patients. In this context, many indications can be listed. The fast clinical response produced, which is often faster than the medication-induced response [8], makes ECT a first-line treatment in urgent clinical situations such as severe suicidality, severe psychosis, catatonia, and malnutrition in patients with food refusal secondary to depressive illness [8, 9]
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