TY - JOUR
T1 - Remission Rates Following Electroconvulsive Therapy and Relation to Index Episode Duration in Patients With Psychotic Versus Nonpsychotic Late-Life Depression
AU - Wagenmakers, Margot J.
AU - Oudega, Mardien L.
AU - Bouckaert, Filip
AU - Rhebergen, Didi
AU - Beekman, Aartjan T. F.
AU - Veltman, Dick J.
AU - Sienaert, Pascal
AU - van Exel, Eric
AU - Dols, Annemieke
N1 - Publisher Copyright: © Copyright 2022 Physicians Postgraduate Press, Inc.
PY - 2022/8/10
Y1 - 2022/8/10
N2 - Objective: Electroconvulsive therapy (ECT) is a safe and effective treatment, especially in psychotic late-life depression (LLD). However, it is not yet clear whether the greater efficacy seen in psychotic LLD is because of a shorter index episode duration. The first aim of this study was to substantiate the superior ECT remission rates in patients with psychotic LLD, as compared to patients with nonpsychotic LLD, and a second aim was to investigate whether this association is independent of the index duration. Methods: 186 patients with LLD treated with ECT were included in the study: 76 from the Valerius cohort (data collection from 2001 to 2006) and 110 from the Mood Disorders Treated with Electroconvulsive Therapy (MODECT) cohort (data collection from 2011 to 2013). The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate depression severity, with remission defined as 2 consecutive MADRS scores < 10. Diagnosis of depression was based on DSM-IV (Valerius) and DSM-IV-TR (MODECT) criteria. A stepwise logistic regression model was built to assess the association between psychotic symptoms, index duration, and remission. Results: Patients with psychotic LLD showed significantly higher remission rates compared to patients with nonpsychotic LLD (68.9% vs 51.0%), independent of index duration, additionally corrected for age, sex, and baseline depression severity (OR = 2.10 [95% CI, 1.07-4.10], P = .03). Conclusions: Patients with psychotic LLD treated with ECT show higher remission rates compared to patients with nonpsychotic LLD. The high remission rates in patients with psychotic LLD are not explained by a shorter index duration. Future studies focusing on neurobiological differences in psychotic versus nonpsychotic depression may indicate why this subtype of depression is very responsive to ECT. Trial Registration: ClinicalTrials.gov identifier: NCT02667353.
AB - Objective: Electroconvulsive therapy (ECT) is a safe and effective treatment, especially in psychotic late-life depression (LLD). However, it is not yet clear whether the greater efficacy seen in psychotic LLD is because of a shorter index episode duration. The first aim of this study was to substantiate the superior ECT remission rates in patients with psychotic LLD, as compared to patients with nonpsychotic LLD, and a second aim was to investigate whether this association is independent of the index duration. Methods: 186 patients with LLD treated with ECT were included in the study: 76 from the Valerius cohort (data collection from 2001 to 2006) and 110 from the Mood Disorders Treated with Electroconvulsive Therapy (MODECT) cohort (data collection from 2011 to 2013). The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate depression severity, with remission defined as 2 consecutive MADRS scores < 10. Diagnosis of depression was based on DSM-IV (Valerius) and DSM-IV-TR (MODECT) criteria. A stepwise logistic regression model was built to assess the association between psychotic symptoms, index duration, and remission. Results: Patients with psychotic LLD showed significantly higher remission rates compared to patients with nonpsychotic LLD (68.9% vs 51.0%), independent of index duration, additionally corrected for age, sex, and baseline depression severity (OR = 2.10 [95% CI, 1.07-4.10], P = .03). Conclusions: Patients with psychotic LLD treated with ECT show higher remission rates compared to patients with nonpsychotic LLD. The high remission rates in patients with psychotic LLD are not explained by a shorter index duration. Future studies focusing on neurobiological differences in psychotic versus nonpsychotic depression may indicate why this subtype of depression is very responsive to ECT. Trial Registration: ClinicalTrials.gov identifier: NCT02667353.
UR - http://www.scopus.com/inward/record.url?scp=85136339829&partnerID=8YFLogxK
U2 - https://doi.org/10.4088/JCP.21m14287
DO - https://doi.org/10.4088/JCP.21m14287
M3 - Article
C2 - 35950901
SN - 0160-6689
VL - 83
JO - The Journal of clinical psychiatry
JF - The Journal of clinical psychiatry
IS - 5
ER -