A symptom-based approach in predicting ECT outcome in depressed patients employing MADRS single items

Abstract

Establishing symptom-based predictors of electroconvulsive therapy (ECT) outcome seems promising, however, findings concerning the predictive value of distinct depressive symptoms or subtypes are limited; previous factor-analytic approaches based on the Montgomery–Åsberg Depression Rating Scale (MADRS) remained inconclusive, as proposed factors varied across samples. In this naturalistic study, we refrained from these previous factor-analytic approaches and examined the predictive value of MADRS single items and their change during the course of ECT concerning ECT outcome. We used logistic and linear regression models to analyze MADRS data routinely assessed at three time points in 96 depressed psychiatric inpatients over the course of ECT. Mean age was 53 years (SD 14.79), gender ratio was 58:38 (F:M), baseline MADRS score was M = 30.20 (SD 5.42). MADRS single items were strong predictors of ECT response, remission and overall symptom reduction, especially items 1 (apparent sadness), 2 (reported sadness) and 8 (inability to feel), assessing affective symptoms. Strongest effects were found for regression models including item 2 (reported sadness) with up to 80% correct prediction of ECT outcome. ROC analyses were performed to estimate the optimal cut-point for treatment response. MADRS single items during the course of ECT might pose simple, reliable, time- and cost-effective predictors of ECT outcome. More severe affective symptoms of depression at baseline and a stronger reduction of these affective symptoms during the course of ECT seem to be positively associated with ECT outcome. Precise cut-off values for clinical use were proposed. Generally, these findings underline the benefits of a symptom-based approach in depression research and treatment in addition to depression sum-scores and generalized diagnoses.

Functional connectivity changes between amygdala and prefrontal cortex after ECT are associated with improvement in distinct depressive symptoms

“…Depressive symptoms are quite heterogeneous, which might not only explain that about 30% of patients do not respond adequately to treatment [ 1 , 43 ] but also underscores the need for a better understanding of the specific effects of a particular treatment on symptomatology. In a previous study, in which we chose a single-item rather than a factor-based approach, we observed that in particular affective symptoms, such as apparent and reported sadness and inability to feel, improved most over the course of ECT [ 10 ]. In the current sample, we observed significant improvements for all four MADRS symptom dimensions, of which changes in the dimensions of sadness, negative thoughts, and detachment were also associated with the observed change in rsFC between the amygdala and DLPFC.…”

“…We previously showed that distinct antidepressant treatments have differential effects on specific symptom dimensions, with improvements in cognitive symptoms after a single sub-anaesthetic dose of ketamine [ 9 ], whereas ECT specifically reduced affective symptoms [ 10 ]. Other studies that examined the relationship between specific symptom dimensions and overall ECT response found that core symptoms such as depressed mood and anhedonia improved more with ECT than somatic or vegetative symptoms [ 2 ].…”

“…Several clinical predictors, such as older age, psychotic symptoms, or higher severity of depression at baseline for treatment response have already been outlined [ 28 – 30 ]. Previously, we could show that especially apparent and reported sadness and inability to feel (measured with the Montgomery-Åsberg Depression Rating Scale, MADRS [ 31 ] at baseline) have predictive value for ECT outcome [ 10 ]. When considering the prognostic value of neural markers, results become more variable across studies.…”

The association between psoriasis and suicide

“…These screening tools and approaches can result in more timely diagnosis and intervention, such as psychosocial support and treatments, all with the goal of reducing the risk of psychological manifestations and suicidality, in hopes of improving the overall prognosis and quality of life in patients suffering from psoriasis. Table 1 [48][49][50][51][52][53][54] summarizes the current instruments available to assess depression and SIs in psoriasis patients.…”

Serum Mature BDNF Level Is Associated with Remission Following ECT in Treatment-Resistant Depression

“…Overall, patients who remain in a depressive episode have a poorer prognosis for their medical condition and an increased use of health services [ 4 ]. In this context, a predictive clinical or biological marker of ECT outcome would be an opportunity to improve patient care and reduce the cost of depressive disorders for the community [ 5 ]. However, the search for a biological marker predicting the future failure or success of ECT remains highly challenging [ 6 , 7 ].…”