Abstract
IntroductionElectroconvulsive therapy (ECT) is an effective treatment for patients with mood disorders and is most often used for treatment‐resistant cases. This study aimed to examine the effectiveness of ECT in a real‐world treatment sample in a Chinese psychiatric hospital which included both treatment‐resistant and nontreatment‐resistant patients.MethodsAn observational study of symptom outcomes from admission to the time of discharge was conducted with 37 inpatients diagnosed with unipolar or bipolar depression treated with ECT. Symptom severity was assessed with the 17‐item Hamilton Rating Scales for Depression (HRSD‐17) and treatment‐resistance with the Maudsley Staging Model (MSM). Stratifying at the MSM median admission characteristics and symptom change was compared between patients who were treatment‐resistant (n = 18) and who were not (n = 19). The outcome difference between groups was compared using analyses of covariance adjusted for baseline characteristics including symptom severity, followed by linear regression to identify factors associated symptom improvement in the entire sample.ResultsThe sample (n = 37) showed moderate treatment‐resistance (MSM = 7.30 ± 1.13) at admission and both groups received 8.3 ± 2 ECT sessions. The treatment‐resistant group had a smaller proportion of bipolar patients and more severe symptoms, but showed no significant difference from the nontreatment‐resistant group in HDRS‐17 scores at the time of discharge (adjusted means = 6.23 ± 1.00 vs. 5.94 ± 0.97, Partial η 2 = 0.001, p = .845). Baseline symptom severity was the strongest correlate of reduction in HDRS‐17 scores (β = 0.891, p < .001).ConclusionsSymptom change with ECT in depression did not differ by level of treatment‐resistance but was greatest among those with more severe baseline symptoms. Correlates of ECT effectiveness should be further evaluated in stratified randomized trials.
Highlights
Electroconvulsive therapy (ECT) is an effective treatment for patients with mood disorders and is most often used for treatment-resistant cases
analysis of covariate (ANCOVA) which did adjust for baseline symptoms showed no significant differences between the groups on depression symptoms at discharge, on the Hamilton Rating Scale for Depression-17 items (HRSD-17) total score, or on any subscale (Partial η2 < 0.1, p > .05) (Table 3)
The linear regression model indicated that HRSD17 decrease was significantly associated with baseline HRSD-17, in value (β = 0.891, p < .001) and percentage change (β = 0.371, p = .024), with Maudsley Staging Model (MSM) score and classification not included in the stepwise models (Table 4)
Summary
Electroconvulsive therapy (ECT) is an effective treatment for patients with mood disorders and is most often used for treatment-resistant cases. This study aimed to examine the effectiveness of ECT in a real-world treatment sample in a Chinese psychiatric hospital which included both treatment-resistant and nontreatment-resistant patients. The outcome difference between groups was compared using analyses of covariance adjusted for baseline characteristics including symptom severity, followed by linear regression to identify factors associated symptom improvement in the entire sample. The treatment-resistant group had a smaller proportion of bipolar patients and more severe symptoms, but showed no significant difference from the nontreatment-resistant group in HDRS-17 scores at the time of discharge (adjusted means = 6.23 ± 1.00 vs 5.94 ± 0.97, Partial η2 = 0.001, p = .845). Conclusions: Symptom change with ECT in depression did not differ by level of treatment-resistance but was greatest among those with more severe baseline symptoms. Correlates of ECT effectiveness should be further evaluated in stratified randomized trials
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