Predictors of Response to Electroconvulsive Therapy Obtained Using the Three-Factor Structure of the Montgomery and Åsberg Depression Rating Scale for Treatment-Resistant Depressed Patients

Okazaki, Mioto; Tominaga, Keiichiro; Higuchi, Hisashi; Utagawa, Itaru; Nakamura, Etsuko; Noguchi, Miwa; Itaya, Mikiko; Hashimoto, Chiaki; Yamaguchi, Noboru

doi:10.1097/yct.0b013e3181b00f32

Cited by 31 publications

(19 citation statements)

References 21 publications

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“…The remaining 1118 citations were screened on the basis of title and abstract; 1085 citations were excluded at this stage. Full‐text review was conducted on the 33 remaining citations, with 14 excluded at this stage: Eight studies did not have head to head comparisons of patients with BDD and/or MDD , three studies did not have measures of ECT efficacy , one study was a letter to the editor citing other included studies , and one study did not define response or remission criteria . Ultimately, 19 studies met our inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

ECT beyond unipolar major depression: systematic review and meta‐analysis of electroconvulsive therapy in bipolar depression

Bahji

Hawken

Sepehry

et al. 2018

Acta Psychiatr Scand

111

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ECT beyond unipolar major depression: systematic review and metaanalysis of electroconvulsive therapy in bipolar depression.Objective: In this systematic review and meta-analysis, the response, remission, and speed of response in adults with major depressive disorder (MDD) and bipolar disorder in depressive episode (BDD) receiving an acute course of electroconvulsive therapy (ECT) were quantitatively analyzed. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 1660 citations were identified through five electronic databases. Nineteen articles met final inclusion criteria for meta-analysis. Results: The pooled response and remission rates with ECT in MDD were 74.2% (n = 1246/1680) and 52.3% (n = 850/1626), respectively. In BDD, they were 77.1% (n = 437/567) and 52.3% (n = 275/377), respectively. Although response rates to ECT were statistically higher in BDD (OR = 0.73, 95% CI: 0.56-0.95, P = 0.02), remission rates were similar (OR = 0.91, 95% CI: 0.65-1.26, P = 0.56). Individuals with BDD vs. MDD required fewer number of ECT sessions to achieve response (SMD = À0.23, 95% CI: À0.44 to À0.023, P = 0.03). There were no significant moderator effects identified. Conclusion: Response rates and speed of response are higher in individuals with BDD; however, remission rates are equivalent. These findings support increased utilization of ECT in individuals with treatment-refractory BDD. Summations• Electroconvulsive therapy is more effective for treating individuals with bipolar vs. unipolar major depression in terms of clinical response, but it was found to be equally effective for achieving remission. Moreover, a smaller number of ECT sessions was needed to achieve clinical response in BDD vs. MDD patients. Considerations• Studies reporting on remission rates were generally heterogeneous in assessing clinical outcomes. A variety of rating scales were applied for measuring response and remission rates. As well, there was a lack of data on outpatients. Furthermore, this meta-analysis synthesized non-randomized study designs rather than randomized controlled trials.

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Section: Resultsmentioning

confidence: 99%

ECT beyond unipolar major depression: systematic review and meta‐analysis of electroconvulsive therapy in bipolar depression

Bahji

Hawken

Sepehry

et al. 2018

Acta Psychiatr Scand

111

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“…133 One study reported that ECT responders displayed higher scores on a MADRS dysphoria factor compared to nonresponders, while the procedure had only a small effect on a MADRS vegetative factor. 143 Although relatively large trials have been conducted in the NIN field, 29,31,144 to the best of our knowledge, there is no published research using machine-learning algorithms to predict NIN response based on a clinical dataset -as has already been done in pharmacological trials. 145 For example, using a gradient boosting model, Chekroud et al 145 identified in STAR*D a dataset of 25 variables that predicted depression response significantly above chance.…”

Section: Convulsive Modalitiesmentioning

confidence: 99%

Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

Borrione

Bellini

Razza

et al. 2020

Braz. J. Psychiatry

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Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although nonimplantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms Brazilian Psychiatric Association 0 0 0 0 0 0 0 0 -0 0 0 2 -7 3 1 6 -1 1 8 5 associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more ''precision-oriented'' practice. DisclosureZ-DD is listed as inventor on patents/patent applications related to brain stimulation technology, assigned to Columbia University and NEVA Electromagnetics, not licensed, and with no remuneration. Although he is an employee of the U.S. government, the views expressed Braz J Psychiatry. 2020;00 (00) Precision NIN for depression

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“…Our recent preliminary research suggested that a higher score on factor 1 was a good predictor of response to ECT in patients with treatment-resistant depression 6. We recruited a further group of old patients and reanalyzed the effects of differences in response to ECT in old patients with treatment-resistant depression (n = 18) by using the three-factor MADRS structure proposed by Suzuki et al5…”

Section: Introductionmentioning

confidence: 99%

Symptom predictors of response to electroconvulsive therapy in older patients with treatment-resistant depression

Tominaga

Okazaki²,

Higuchi³

et al. 2011

IJGM

Self Cite

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Background:Electroconvulsive therapy (ECT) has been used for treatment-resistant depression. However, predictors of response to ECT have not been adequately studied using the Montgomery and Åsberg Depression Rating Scale, especially in older patients with treatment-resistant depression.Methods:This study included 18 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for a diagnosis of major depressive disorder or bipolar disorder with a current major depressive episode, and met the definition of treatment-resistant depression outlined by Thase and Rush, scoring ≥21 on the Montgomery and Åsberg Depression Rating Scale. The three-factor model of the Montgomery and Åsberg Depression Rating Scale was used for analysis. Factor 1 was defined by three items, factor 2 by four items, and factor 3 by three items, representing dysphoria, retardation, and vegetative symptoms, respectively. ECT was performed twice a week for a total of six sessions using a Thymatron System IV device with the brief pulse technique. Clinical responses were defined on the basis of a ≥50% decrease in total pretreatment Montgomery and Åsberg Depression Rating Scale scores.Results:The mean pretreatment factor 2 score for responders (n = 7) was significantly lower than that for nonresponders (n = 11). Furthermore, a significant difference in mean factor 3 score between responders and nonresponders was observed one week after six sessions of ECT, indicating a time lag of response. No significant differences were observed for age, number of previous episodes, and duration of the current episode between responders and nonresponders.Conclusion:This study suggests that a low pretreatment factor 2 score is a good predictor of response to ECT in older patients with major depression.

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Predictors of Response to Electroconvulsive Therapy Obtained Using the Three-Factor Structure of the Montgomery and Åsberg Depression Rating Scale for Treatment-Resistant Depressed Patients

Abstract: This study suggests that a high factor 1 MADRS score at pretreatment was a good predictor of response to ECT in patients with treatment-resistant MDD.

Cited by 31 publications

References 21 publications

ECT beyond unipolar major depression: systematic review and meta‐analysis of electroconvulsive therapy in bipolar depression

ECT beyond unipolar major depression: systematic review and meta‐analysis of electroconvulsive therapy in bipolar depression

Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

Symptom predictors of response to electroconvulsive therapy in older patients with treatment-resistant depression

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