Effectiveness of electroconvulsive therapy in patients with “less treatment‐resistant” depression by the Maudsley Staging Model

Abstract

Introduction 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. Methods An 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. Results The 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). 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.

Factors associated with antidepressant responses to repetitive transcranial magnetic stimulation in antidepressant-resistant depression

“…However, a study that investigated the effectiveness of ECT reported that inpatients who were identified through the MSM 10.3389/fnins. 2022.1046920 to have TRD (n = 18) did not differ significantly from inpatients without TRD in terms of their depression scores at the time of psychiatric discharge (Ma et al, 2020). In addition, Hägg et al (2020) compared patients with TRD who were identified through various staging methods, and they reported that MSMidentified TRD [adjusted hazard ration (aHR) = 0.95, 0.94-0.97] and MGH-identified TRD (aHR = 0.92, 0.92-0.94) were associated with a slightly reduced risk, whereas ESM-identified TRD was associated with higher non-significant, marginal risk for psychiatric hospitalization (aHR = 1.03, 95% confidence interval = 1.00-1.05).…”

Potential mechanisms of action and effectiveness of electroconvulsive therapy in the treatment of depressive disorders

“…Terapia elektrowstrząsowa (ECT) jest znana ludzkości od wielu dekad, a za jej pioniera w Polsce uważa się wileńskiego lekarza Klemensa Maleszewskiego który już w 1861 roku z sukcesem wykorzystał prąd elektryczny do leczenia pacjenta z katatonią [11]. Terapia elektrowstrząsowa jest powszechnie uważana za najskuteczniejszą metodę leczenia depresji i najczęściej jest stosowana gdy leki antydepresyjne nie przyniosą odpowiedniej poprawy klinicznej na przykład w depresji lekoopornej (TRD) oraz w nagłych przypadkach psychiatrycznych takich jak próba samobójcza, ciężka katatonia, złośliwy zespół neuroleptyczny [9] . Metoda skuteczna w leczeniu depresji jedno-i dwubiegunowej [8], odpowiednia dla pacjentów w podeszłym wieku i z chorobami towarzyszącymi w tym chorobami serca, płuc i neurologicznymi [10].…”

“…Terapia elektrowstrząsowa jest powszechnie uważana za najskuteczniejszą metodę leczenia depresji i najczęściej jest stosowana gdy leki antydepresyjne nie przyniosą odpowiedniej poprawy klinicznej na przykład w depresji lekoopornej (TRD) oraz w nagłych przypadkach psychiatrycznych takich jak próba samobójcza, ciężka katatonia, złośliwy zespół neuroleptyczny [9] . Metoda skuteczna w leczeniu depresji jedno-i dwubiegunowej [8], odpowiednia dla pacjentów w podeszłym wieku i z chorobami towarzyszącymi w tym chorobami serca, płuc i neurologicznymi [10]. Obecnie ECT jest uznawane za najskuteczniejszą metodę leczenia niektórych rodzajów depresji, a ponadto żadne badanie kontrolowane nie wykazało, że inna forma leczenia jest lepsza od ECT w krótkoterminowym leczeniu ciężkiej depresji.…”

The impact of treatment resistance on outcome and course of electroconvulsive therapy in major depressive disorder

“…However, others did not find a difference in ECT-effectiveness between patients with TRD versus non-treatment resistance, but the included sample size was small. 21 To our knowledge, the DM-TRD has not yet been investigated regarding its predictive value for treatment outcome in ECT.…”

“…The tendency to position ECT as "treatment-of-last-resort" may decrease the likelihood of beneficial outcome, but the impact of the level of treatment resistance on ECToutcome has only been studied in small samples. 20,21 In ECT patients, examined with the MSM, Van Diermen et al 20,22 have shown that a longer depression duration, less severe depression severity and having had more failed antidepressants were associated with decreased ECT-effectiveness. However, others did not find a difference in ECT-effectiveness between patients with TRD versus non-treatment resistance, but the included sample size was small.…”