BACKGROUND: Research examining the course of depressive symptoms during electroconvulsive therapy (ECT) is relatively scarce. OBJECTIVE: To classify patients according to the course of their depressive symptoms while receiving ECT. METHODS: The sample consisted of 156 consecutive patients receiving ECT for unipolar depressive disorder. Depressive symptoms were measured weekly with the Montgomery-Asberg Depression Rating Scale. Latent class analysis was applied to identify distinct trajectories of symptom improvement. RESULTS: We identified five classes of different trajectories (improvement rates) of depressive symptoms, i.e. fast improvement (39 patients), intermediate improvement (47 patients), slow improvement (30 patients), slow improvement with delayed onset (18 patients), and finally a trajectory with no improvement (20 patients). The course of depressive symptoms at the end of the treatment within the trajectories of intermediate improvement, slow improvement and slow improvement with delayed onset, was still improving and did not achieve a plateau. CONCLUSION: The different courses of depressive symptoms during ECT probably contribute to mixed results of prediction studies of ECT outcome. Data suggest that for a large group of patients no optimal clinical endpoint can be identified, other than full remission or no improvement at all, to discontinue ECT.
BACKGROUND: Research examining the course of depressive symptoms during electroconvulsive therapy (ECT) is relatively scarce. OBJECTIVE: To classify patients according to the course of their depressive symptoms while receiving ECT. METHODS: The sample consisted of 156 consecutive patients receiving ECT for unipolar depressive disorder. Depressive symptoms were measured weekly with the Montgomery-Asberg Depression Rating Scale. Latent class analysis was applied to identify distinct trajectories of symptom improvement. RESULTS: We identified five classes of different trajectories (improvement rates) of depressive symptoms, i.e. fast improvement (39 patients), intermediate improvement (47 patients), slow improvement (30 patients), slow improvement with delayed onset (18 patients), and finally a trajectory with no improvement (20 patients). The course of depressive symptoms at the end of the treatment within the trajectories of intermediate improvement, slow improvement and slow improvement with delayed onset, was still improving and did not achieve a plateau. CONCLUSION: The different courses of depressive symptoms during ECT probably contribute to mixed results of prediction studies of ECT outcome. Data suggest that for a large group of patients no optimal clinical endpoint can be identified, other than full remission or no improvement at all, to discontinue ECT.
Authors: Takahiro Soda; Declan M McLoughlin; Scott R Clark; Leif Oltedal; Ute Kessler; Jan Haavik; Chad Bousman; Daniel J Smith; Miquel Bioque; Caitlin C Clements; Colleen Loo; Fidel Vila-Rodriguez; Alessandra Minelli; Brian J Mickey; Roumen Milev; Anna R Docherty; Julie Langan Martin; Eric D Achtyes; Volker Arolt; Ronny Redlich; Udo Dannlowski; Narcis Cardoner; Emily Clare; Nick Craddock; Arianna Di Florio; Monika Dmitrzak-Weglarz; Liz Forty; Katherine Gordon-Smith; Mustafa Husain; Wendy M Ingram; Lisa Jones; Ian Jones; Mario Juruena; George Kirov; Mikael Landén; Daniel J Müller; Axel Nordensköld; Erik Pålsson; Meethu Paul; Agnieszka Permoda; Bartlomiej Pliszka; Jamie Rea; Klaus O Schubert; Joshua A Sonnen; Virginia Soria; Will Stageman; Akihiro Takamiya; Mikel Urretavizacaya; Stuart Watson; Maxim Zavorotny; Allan H Young; Eduard Vieta; Janusz K Rybakowski; Massimo Gennarelli; Peter P Zandi; Patrick F Sullivan; Bernhard T Baune Journal: Eur Arch Psychiatry Clin Neurosci Date: 2019-12-04 Impact factor: 5.270