Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Abstract

Introduction: Electroconvulsive therapy (ECT) is known to be an effective option in the treatment of mood disorders, especially resistant depression. However, the remission achieved by ECT was reported to be not long lasting enough. The aim of the present study was to investigate the relapse/recurrence rates and associated risk factors during the first year after ECT in patients diagnosed with mood disorders.Methods: In a naturalistic observation, patients diagnosed with unipolar depressive disorder or a depressive episode of bipolar disorder and who had achieved remission by ECT were followed up for at least one year. The patients were evaluated with structured interviews during the follow-up period. The relapse/recurrence rates were the primary outcome measurements, while hospitalization and suicide attempts were the secondary outcome measurements. The remitted and non-remitted patients were compared regarding the clinical features, ECT, and pharmacological variables.Results: Fifty of 62 patients who had achieved remission with ECT completed the one year follow-up period. Thirty-three patients (66%) had relapse/recurrence, while 17 (34%) patients remained in remission. The relapse rates were similar in patients with unipolar depression and bipolar disorders. The mean number of ECT sessions was higher in relapsed patients with bipolar disorders. Multiple episodes were more frequent in non-remitted patients with unipolar depression. Comorbid psychiatric diagnosis was higher in non-remitted patients with unipolar and bipolar disorders. Conclusion:The relapse/recurrence rate was found to be fairly high in the first year of follow-up in patients who had achieved remission with ECT. ECT decisions should be made carefully in patients with comorbid psychiatric diagnosis and multiple episodes as these are more risky. The ECT application procedure and successive maintenance treatment (maintenance ECT, pharmacotherapy, and psychotherapy) should be planned to sustain the remission for patients with mood disorders in long-term follow-up.Keywords: Electroconvulsive therapy, mood disorders, relapse, remission, major depression Arch Neuropsychiatry 2017; 54: 196-201 • DOI: 10.5152/npa.2016.14845 Electroconvulsive ABSTRACT INTRODUCTONThe efficacy of pharmacotherapy in mood disorders is not satisfactory, and the desired remission rates are not currently achieved in either unipolar (UD) or bipolar disorders (BP) (1,2,3). Electroconvulsive therapy (ECT) has been used for a long time with successful response and remission rates; 80-90% of patients experience an improvement, and the efficacy of ECT has been established to be between 60% and 90% regarding acute response in treatment-resistant depression (3,4,5,6,7). ECT is also considered to be an effective treatment in bipolar depression and is indicated to be equally effective in unipolar and bipolar depression (8,9,10). The effectiveness of ECT in the treatment of UD and BP has also been reported, and it is recommended by guidelines (11,12,13,14). However, the literature data...

EffECTively Treating Depression: A Pilot Study Examining Manualized Group CBT as Follow-Up Treatment After ECT

“…In general, severely depressed patients treated with ECT are prone to relapse, even after a successful course of ECT treatment. Relapse and rehospitalization rates within six to 12 months after acute ECT are high (up to 66%, Cakir and Caglar, 2017), and relapse rates remain high even with continuation ECT or concomitant pharmacological treatment (34-47%; Sackeim et al, 2001;Jelovac et al, 2013;Brakemeier et al, 2014;Verwijk et al, 2015). In our sample, only one patient was rehospitalized during the course of the study and 92.8% of the patients either maintained or improved with regard to their depressive symptoms.…”

Suicidal Ideation and Electroconvulsive Therapy

“…What little available data we have suggest an approximately 40% relapse rate at 6 months post-ECT, and recurrence rate at 1 year reached as high as 50% to 60%. 39,40 Therefore, evaluating the long-term efficacy of ECT through prolonged follow-up is a future aim of research on applying this treatment to MDD. Short-term impairment in cognitive function after ECT is currently an accepted result for adults, 12 but whether those effects are long-term remains controversial.…”

Can seizure therapies and noninvasive brain stimulations prevent suicidality? A systematic review

“…Notwithstanding the limited and discordant evidence base for ECT in mood disorders, ECT remains a valuable therapeutic option with superior to PEDro level 2 to acutely reduce suicidal ideations. Continuative ECT treatment, including maintenance pharmacotherapy or psychotherapy, should be sustained during the long term to prolong the remission phase (Çakir & Çağlar, 2017).…”