Dear Sir:We read with interest the paper “The Relationship between Symptom Relief and Psychosocial Functional Improvement during Acute Electroconvulsive Therapy for Patients with Major Depressive Disorder” by Lin and Yang (Lin and Yang, 2017). The topic is important and we congratulate them on their work. However, when we originally read the conclusions from the abstract, we saw that “Symptom reduction did not predict subsequent functional improvement” and were alarmed that perhaps the authors found that ECT did not improve function. We were relieved to see that in the Discussion of the main body of the paper, Figure 1 shows an approximately 30% reduction in the Modified Work and Social Adjustment Scale (MWSAS) at the conclusion of ECT, and the reported effect size (Table 1) at the end of ECT is also very large (1.67). Unfortunately, this good news was lost in the abstract.In our opinion, the most important finding of the paper is that functional improvement lags behind symptomatic improvement after the administration of ECT. However, contrary to the assertion in their Discussion, their paper is not the first to describe the impact of ECT on function. We have previously reported the impact of ECT on activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in depressedpatients, with a time window that extended up to 12 months after ECT (McCall et al., 2001). We found that while depression scores were maximally improved by the end of acute treatment, functional status was not optimized until up to 3 months later. Further, we found that functional improvement was superior in patients who received ECT compared with those who received antidepressant medication management.We examined this question a second time a few years later in a new sample of depressedpatients receiving ECT examining ADL and IADL function at baseline and at 2 and 4 weeks post ECT (McCall et al., 2004). In this study, we found that maximal improvement in IADL scores did not plateau for at least 4 weeks post ECT. We further went on to show that the ECTpatients’ report of their ADL and IADL function was consistent with their loved one’s impression (McCall et al., 2002).Lin and Yang conclude their paper with a call for research to determine whether objective measurement of memory explains some part of the changes seen (or not seen) in function after ECT. We had previously reported that changes in the Mini Mental State Exam score indeed had some relationship with changes in IADL scores after ECT, but measures of anterograde verbal memory and retrograde autobiographical memory were not related to IADL change scores. (McCall et al., 2004).Again we applaud the work of Lin and Yang in contributing to the existing literature on the relationship between ECT and function.
Statement of Interest
Dr McCall has been a scientific advisor for Merck and Israeli Growth Partners and a consultant to Luitpold Pharmaceuticals, Inc.; Multiple Energy Technologies, LLC; and Anthem Insurance Company. Dr McCall receives research support from MECTA and Merck and royalties from Wolters Kluwer. Dr. Kellner receives honoraria from UpToDate, Psychiatric Times, and Northshore-LIJ Health System and is a consultant to Luitpold Pharmaceuticals, Inc.