Abstract
ObjectiveElectroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression.MethodsData were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression – Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio‐demographic and clinical factors and response.ResultsResponse was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive‐compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate.ConclusionElectroconvulsive therapy for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive‐compulsive disorder or personality disorder, and less prior pharmacologic treatment.
Highlights
Electroconvulsive therapy (ECT) is an effective treatment option for patients that suffer from severe depression with response rates of 65.8–80% [1,2,3,4]
ECT is used in both major depressive disorder (MDD) and bipolar depression the strength of evidence for bipolar depression is lower
Most studies that investigated efficacy of ECT in bipolar depression appear to show no inferiority of ECT in response and remission rates when compared with major depressive disorder [3,4,5,6,7], but there are reports of bipolarity being a prognostic factor of nonresponse to ECT [1, 8]
Summary
Electroconvulsive therapy (ECT) is an effective treatment option for patients that suffer from severe depression with response rates of 65.8–80% [1,2,3,4]. Most studies that investigated efficacy of ECT in bipolar depression appear to show no inferiority of ECT in response and remission rates when compared with major depressive disorder [3,4,5,6,7], but there are reports of bipolarity being a prognostic factor of nonresponse to ECT [1, 8]. An association between age and response to ECT is relevant as pharmacological treatment in elderly depressed patients are sometimes contraindicated for its side effects. Some studies on patients with unipolar or mixed uni- and bipolar samples indicate that older age is a prognostic factor for better ECT efficacy [5, 13, 14, 17]. One prospective study investigated the influence of failure of adequate treatment with TCAs and lithium on ECT outcomes and found no such association [22]
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