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Original Research

The Efficacy of Acute Electroconvulsive Therapy in Atypical Depression

Mustafa M. Husain, MD; Shawn M. McClintock, PhD; A. John Rush, MD; Rebecca G. Knapp, PhD; Max Fink, MD; Teresa A. Rummans, MD; Keith Rasmussen, MD; Cynthia Claassen, PhD; Georgios Petrides, MD; Melanie M. Biggs, PhD; Martina Mueller, PhD; Shirlene Sampson, MD; Samuel H. Bailine, MD; Sarah H. Lisanby, MD; and Charles H. Kellner, MD

Published: March 14, 2008

Article Abstract

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 therapy (ECT).

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.

Volume: 69

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