Precision ECT for major depressive disorder: A review of clinical factors, laboratory, and physiologic biomarkers as predictors of response and remission

Abstract

Predicting which patient(s) will respond to Electroconvulsive Therapy (ECT) has very important clinical implications. The aim of this manuscript is to review the current literature on clinical, physiologic and laboratory biomarkers as predictors of ECT response and remission related to the treatment of major depressive disorder (MDD). We will briefly discuss available research on the predictors of cognitive side effects of ECT. Although each clinical factor may have subtle influence on ECT response, taken together clinical predictors can lead to a robust treatment plan tailored for an individual patient, and advise on the likelihood of ECT response. Available literature supports the predictive value of several clinical factors. Older age, psychotic depression, and depression severity positively predict ECT response. Limited data is available for catatonia specific to MDD, but overall data shows positive response of ECT for the treatment of catatonia. Multiple medication trials in the current episode and comorbid psychiatric diagnosis (including borderline personality disorder and substance use disorder) predict lower response.Lack of widespread clinical availability and validation in larger studies limits current clinical utility of laboratory and physiologic biomarkers. Genetic, epigenetic, and proteomic factors have been investigated predominately in animal models, but ongoing research in human studies including neuroimaging is promising. Thus, these biomarkers provide an exciting outlook that may elevate the precision of ECT response and remission.