Alexandre Y. Dombrovski, MD; Benoit H. Mulsant, MD; Roger F. Haskett, MD; Joan Prudic, MD; Amy E. Begley, MA; and Harold A. Sackeim, PhD
Context: Electroconvulsive therapy (ECT) is the
most effective biological treatment for major depression.
However, there is little agreement about clinically useful
predictors of acute ECT outcomes.
Objective: To assess whether age, sex,
burden of comorbid physical illness, age at onset, history of
recurrence, episode duration, chronic depression or comorbid
dysthymia, melancholic features, episode severity, and medication
resistance are predictors of remission after an acute course of
ECT.
Design: We performed an analysis using data
gathered prospectively in 328 patients with unipolar major
depression (according to Research Diagnostic Criteria) treated
with ECT. The study was conducted from 1993 through 1999.
Patients had a pretreatment score of 21 or higher on the 24-item
Hamilton Rating Scale for Depression (HAM-D). Treatment history
was assessed using the Antidepressant Treatment History Form.
Remission was defined as a 24-item HAM-D score of 10 or less and
a 60% or more relative reduction of the HAM-D score.
Results: On univariate logistic regression,
statistically significant predictors of nonremission were chronic
depression/dysthymia, medication resistance, longer episode
duration, and younger age. On backward elimination logistic
regression, only medication resistance (OR = 1.67, 95% CI = 1.05 to
2.67) and chronic depression/dysthymia (OR = 1.84, 95% CI = 1.06 to
3.21) were statistically significant predictors of nonremission.
Conclusions: In patients with major
depression, lower rates of remission after acute ECT are
associated with medication resistance and chronicity, but not
with age or burden of physical illness.
J Clin Psychiatry 2005;66(8):1043-1049
© Copyright 2005 Physicians Postgraduate Press, Inc.