The Efficacy of Acute Electroconvulsive Therapy in Atypical Depression
J Clin Psychiatry 2008;69(3):406-411
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: This study examined the characteristics and
outcomes of patients with major depressive disorder (MDD), with or without
atypical features, who were treated with acute bilateral electroconvulsive
Method: Analyses were conducted with 489 patients who met
DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the
basis of the Structured Clinical Interview for DSM-IV obtained at baseline
prior to ECT. Depression symptom severity was measured by the 24-item Hamilton
Rating Scale for Depression (HAM-D24) and the 30-item Inventory of
Depressive Symptomatology-Self-Report (IDS-SR30). Remission was
defined as at least a 60% decrease from baseline in HAM-D24 score
and a total score of 10 or below on the last 2 consecutive HAM-D24
ratings. The randomized controlled trial was performed from 1997 to 2004.
Results: The typical (N = 453) and atypical (N = 36) groups
differed in several sociodemographic and clinical variables including gender (p
= .0071), age (p = .0005), treatment resistance (p = .0014), and age at first
illness onset (p < .0001) and onset of current episode (p = .0008). Following
an acute course of bilateral ECT, a considerable portion of both the typical
(67.1%) and the atypical (80.6%) groups reached remission. The atypical group
was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group
after adjustment for age, psychosis, gender, clinical site, and depression
severity based on the HAM-D24.
Conclusion: Acute ECT is an efficacious treatment for
depressed patients with typical or atypical symptom features.