Abstract
ObjectiveTo validate a faster speed of response to electroconvulsive therapy (ECT) for bipolar depression (BPD) compared to major depressive disorder (MDD) MethodRetrospective chart review on an ECT cohort in an academic hospital setting. Speed of response was defined by the number of ECT treatments needed for response or remission. ResultsSixty-four depressed patients were included, of whom 53 (MDD: 40, BPD: 13) could be analyzed. The bipolar group responded faster with a mean difference of 3.3 fewer ECT treatments to meet response criteria (MDD 10.4 vs. BPD 7.1, p = 0.054). When using mixed effects regression models for the response/remitter group (n = 35), a faster response for the bipolar group (AIC 252.83 vs 258.55, χ2 = 11.72, p = 0.008) was shown. Other factors, such as psychotic features or comorbidity, did not influence the speed of response. ConclusionThis chart review of an ECT cohort in an naturalistic academic hospital setting shows an evident and clinically relevant faster speed of response in bipolar depression.
Highlights
Electroconvulsive therapy (ECT) is the most effective treatment used to treat severe and refractory depressive episodes. (Brus et al, 2017; Geddes et al, 2003; Kho et al, 2003) The chances of remission depend on the features of the depressive episode and co-morbidity, such as personality disorders. (Newton-Howes et al, 2014) Remission is ach ieved in around 50% of both major depressive disorder (MDD) and bi polar depression (BPD), and higher rates are reported for depression with psychotic features (63%–95%). (Brus et al, 2017; Dierckx, Heijnen, van den Broek and Birkenhager, 2012; Geddes et al, 2003; Petrides et al, 2001) Besides response and remission, ECT is associated with reduced short-term psychiatric inpatient readmissions for severe affec tive disorders. (Slade et al, 2017)
Multiple studies have indicated that fewer ECT sessions were needed to treat bipolar depression. (Daly et al, 2001; Sienaert et al, 2009) A meta-analysis from 2012 showed that ECT is effective in MDD versus BPD, but indicated that there were not enough studies at that point for a conclusion on speed of response. (Dierckx et al, 2012) A more recent review from 2018 on the speed of antidepressant response, indicated a potentially brisker speed of response in BPD and that further research is needed. (Agarkar et al, 2018) A faster speed of response has implications for an earlier indication of ECT, as a rapid relief of severe
This is in line with the meta-analysis of Dierckx et al which showed comparable remission rates of around 50% in unipolar vs bipolar depression. (Dierckx et al, 2012) when examining psychotic features, we found a significantly higher response and a trend towards a higher remission rate in the psychotic group
Summary
Electroconvulsive therapy (ECT) is the most effective treatment used to treat severe and refractory depressive episodes. (Brus et al, 2017; Geddes et al, 2003; Kho et al, 2003) The chances of remission depend on the features of the depressive episode and co-morbidity, such as personality disorders. (Newton-Howes et al, 2014) Remission is ach ieved in around 50% of both major depressive disorder (MDD) and bi polar depression (BPD), and higher rates are reported for depression with psychotic features (63%–95%). (Brus et al, 2017; Dierckx, Heijnen, van den Broek and Birkenhager, 2012; Geddes et al, 2003; Petrides et al, 2001) Besides response and remission, ECT is associated with reduced short-term psychiatric inpatient readmissions for severe affec tive disorders. (Slade et al, 2017).there consists a large heterogeneity in the trajectories of ECT response in different patient groups. (Brus et al, 2017; Geddes et al, 2003; Kho et al, 2003) The chances of remission depend on the features of the depressive episode and co-morbidity, such as personality disorders. (Brus et al, 2017; Dierckx, Heijnen, van den Broek and Birkenhager, 2012; Geddes et al, 2003; Petrides et al, 2001) Besides response and remission, ECT is associated with reduced short-term psychiatric inpatient readmissions for severe affec tive disorders. (Haq et al, 2015; Heijnen, Birkenhager, Wierdsma, & Van Den Broek, 2010; Heijnen et al, 2019; Newton-Howes et al, 2014; Van Diermen et al, 2018) Co-morbid (personality) disor ders have a negative predictive value for response. Multiple studies have indicated that fewer ECT sessions were needed to treat bipolar depression. (Daly et al, 2001; Sienaert et al, 2009) A meta-analysis from 2012 showed that ECT is effective in MDD versus BPD, but indicated that there were not enough studies at that point for a conclusion on speed of response. (Dierckx et al, 2012) A more recent review from 2018 on the speed of antidepressant response, indicated a potentially brisker speed of response in BPD and that further research is needed. (Agarkar et al, 2018) A faster speed of response has implications for an earlier indication of ECT, as a rapid relief of severe
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