Health-Related Quality of Life in a Clinical Trial of ECT Followed by Continuation Pharmacotherapy

McCall, W. Vaughn; Rosenquist, Peter B.; Kimball, James; Haskett, Roger F.; Isenberg, Keith; Prudic, Joan; Lasater, Barbara; Sackeïm, Harold A.

doi:10.1097/yct.0b013e318205c7d7

Cited by 28 publications

(18 citation statements)

References 15 publications

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“…We suspect that impaired HRQOL contributes to referral decisions for ECT. ECT leads to short-term improvement in HRQOL for most patients, (McCall WV et al, 2011;McCall et al, 2004;McCall et al, 2006) and sustained remission after ECT produces further improvement in HRQOL with near-normalization of HRQOL values. Unfortunately, not all patients benefit from ECT and depressive relapse is common after acute response, leading to a loss of improvement in HRQOL.…”

Section: Discussionmentioning

confidence: 97%

“…Unfortunately, not all patients benefit from ECT and depressive relapse is common after acute response, leading to a loss of improvement in HRQOL. (McCall WV, Rosenquist PB, Kimball, Haskett R, Isenberg, Prudic, Lasater, and Sackeim, 2011;McCall, Prudic, Olfson, and Sackeim, 2006) Only a minority of patients achieves sustained remission following ECT. When this is accomplished, there appears to be full normalization of HRQOL 6 months after ECT.…”

Section: Discussionmentioning

confidence: 99%

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Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT

McCall

Reboussin

Prudic

et al. 2013

Journal of Affective Disorders

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Background Health-related quality of life (HRQOL) is diminished in depressed adult outpatients and especially impaired among depressed patients referred for ECT. We compare pretreatment HRQOL in ECT and non-ECT depressed patients from two large samples, and examined whether sustained remission in depressive symptoms after ECT is associated with normalization of HRQOL. Methods HRQOL was measured with the Medical Outcomes Study Short Form 36 (SF36) before ECT and 6 months after ECT in an effectiveness (n=286) and an efficacy (n=243) clinical trial. Results ECT patients had very low baseline SF36 scores. With one exception, SF36 subscale scores in both trials were significantly lower than those of depressed outpatients. A minority of patients in both trials entered and sustained remission over the 24 week timeframe. Among sustained remitters, average SF36 scores were no different from normative scores of the general adult population, except that in the effectiveness study ECT patients reported less Bodily Pain (p<0.05) and better Mental Health (p<0.05), while in the efficacy study ECT patients reported more difficulty with Role-Emotional. (p<0.01) Limitations Only a modest number of patients were observed in sustained remission. Conclusions HRQOL is very poor in patients referred for ECT. Depressed patients who experience sustained remission after ECT, however, can expect improvement in their quality of life that leaves many in a position indistinguishable from the general adult population.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT

McCall

Reboussin

Prudic

et al. 2013

Journal of Affective Disorders

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“…ECT has also been reported to enhance health-related quality of life and activities of daily living. 7 Bilateral ECT is more powerful than low-dose unilateral ECT but is associated with more effects on cognitive function. At higher doses, unilateral ECT is as effective as bilateral ECT but may have just as many adverse effects.…”

Section: Electroconvulsive Therapymentioning

confidence: 99%

Physical treatments

Dunne¹,

McLoughlin²

2012

Medicine

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Electroconvulsive therapy (ECT) is the most effective treatment available for severe depression, with a remission rate of 60%. It is a safe procedure and the major medical risks are related to anaesthesia (mortality 1:80,000). Early use of ECT is associated with shorter and less costly hospital stays and it is reported to enhance health-related quality of life and activities of daily living. Bilateral ECT is more powerful than low-dose unilateral ECT but is associated with more effects on cognitive function. The precise mechanism of action of ECT is not yet known, but in animal models it up-regulates neurotrophic factors and induces hippocampal neurogenesis and synaptogenesis. Recent evidence suggests that repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for moderate depression when compared to placebo treatment alone. Vagus nerve stimulation (VNS) and deep brain stimulation (DBS) remain experimental treatments. Stereotactic neurosurgery for mental illness is practised only in specialized centres for intractable illness, but has a good outcome in selected patients.

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“…In this study, HRQOL was unrelated to changes in cognitive function. (McCall WV et al, 2011) The ECT Services study included 283 mixed-age participants with MDD (mean age 55.4 years) treated with ECT according to provider preference and HRQOL was measured with the Medical Outcomes Study Short Form 36 (SF-36). In this study, improvement was seen widespread, with 87% of participants showing improved scores, with remitters showing approximately an effect size of 1.0, and non-remitters had an improvement effect size of approximately 0.5.…”

Section: Introductionmentioning

confidence: 99%

Effects of a right unilateral ultrabrief pulse electroconvulsive therapy course on health related quality of life in elderly depressed patients

McCall

Lisanby

Rosenquist

et al. 2017

Journal of Affective Disorders

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Introduction Patients with Major Depressive Disorder (MDD) referred for electroconvulsive therapy (ECT) have poorer Health Related Quality of Life (HRQOL), compared with other patients with MDD, but ECT is associated with significant and durable improvement in HRQOL. However, no prior research has focused exclusively on elderly patients with MDD receiving ECT. Methods HRQOL data from 240 depressed patients over the age of 60 was measured with the Medical Outcomes Study Short Form 36 (SF-36). The SF-36 was measured before and after a course of acute ECT. Predictors of change in HRQOL scores were identified by generalized linear modeling. Results At baseline, participants showed very poor HRQOL. After treatment with ECT, the full sample showed marked and significant improvement across all SF-36 measures, with the largest gains seen in dimensions of mental health. Across all participants, the Physical Component Summary (PCS) score improved by 2.1 standardized points (95% CI, 0.61,3.56), while the Mental Component Summary (MCS) score improved by 12.5 points (95% CI, 7.2,10.8) Compared with non-remitters, remitters showed a trend toward greater improvement in the PCS summary score of 2.7 points (95%CI, −0.45, 5.9), while the improvement in the MCS summary score was significantly greater (8.5 points, 95% CI, 4.6,12.3) in the remitters than non-remitters. Post-ECT SF-36 measurements were consistently and positively related to baseline scores and remitter/non-remitter status or change in depression severity from baseline. Objective measures of cognitive function had no significant relationships to changes in SF-36 scores. Limitations This study’s limitations include that it was an open label study with no comparison group, and generalizability is limited to elderly patients. Discussion ECT providers and elderly patients with MDD treated with ECT can be confident that ECT will result in improved HRQOL in the short-term. Attaining remission is a key factor in the improvement of HRQOL. Acute changes in select cognitive functions were outweighed by improvement in depressive symptoms in determining the short term HRQOL of the participants treated with ECT.

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Health-Related Quality of Life in a Clinical Trial of ECT Followed by Continuation Pharmacotherapy

Cited by 28 publications

References 15 publications

Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT

Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT

Physical treatments

Effects of a right unilateral ultrabrief pulse electroconvulsive therapy course on health related quality of life in elderly depressed patients

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