Article Summary
Clinical Summary: Depression Remission and Response Rates and Anxiety Response as a Predictor of Depression Response in a Community Electroconvulsive Therapy Clinic
Patients referred for ECT in community practice often have severe, highly treatment-resistant depression and multiple comorbidities, yet the remission rates most clinicians hear about often come from more selective trial populations. This study shows what outcomes looked like in a real-world community ECT clinic and identifies anxiety burden as a practical marker tied to depression response.
Design
We performed a retrospective chart review
N
Thirty-five patients were included in the study.
Population
Eligible participants were patients aged 18 years and older who were treated with an acute series of ECT from March 1, 2014, to March 9, 2015.
Duration
from March 1, 2014, to March 9, 2015
Key Findings
- Overall, 19 patients (54.3%) had depression response on the PHQ-9, and 11 patients (31.4%) met remission criteria as measured by the PHQ-9.
- Nineteen patients (54.3%) had response of anxiety symptoms, as measured by 50% reduction in GAD-7 score; among patients who exhibited a response on the PHQ-9, 84.2% also exhibited a response on the GAD-7.
- Improvements in anxiety were significantly associated with depression response, with logistic regression ORs of 1.407 (95% CI, 1.113–1.779, P=.004) for PHQ-9 response and 1.281 (95% CI, 1.033–1.588, P=.024) for HAMD-17 response.
- Patients with initial severe anxiety scores (GAD-7≥15) were less likely than other patients to exhibit a response in depression as measured by the PHQ-9 (χ21 [N=35]=4.900, P=.027 [41.7% vs 81.8%]).
- Initial PHQ-9 scores did not predict PHQ-9 response rates (odds ratio [OR] = 1.062, 95% CI, 0.780–1.446, P = .701), and initial GAD-7 scores also did not predict PHQ-9 response rates, OR=0.950 (95% CI, 0.812–1.112, P=.523).
Clinical Bottom Line
In this community ECT clinic, about half of patients with highly treatment-resistant depression responded and about one-third remitted. Baseline severe anxiety identified patients less likely to achieve depression response, and improvement in anxiety tracked closely with improvement in depression.
Practice Implications
- Set expectations using community-based outcomes: 54.3% achieved PHQ-9 response and 31.4% achieved PHQ-9 remission, which are lower than remission rates commonly cited from controlled trials.
- Assess anxiety systematically before starting ECT, because patients with initial severe anxiety scores (GAD-7≥15) had lower depression response rates than other patients (41.7% vs 81.8%).
- Monitor anxiety symptoms during the ECT course, not just depressive symptoms, because anxiety improvement was significantly associated with both PHQ-9 response (OR 1.407, 95% CI, 1.113–1.779, P=.004) and HAMD-17 response (OR 1.281, 95% CI, 1.033–1.588, P=.024).
- Address early discontinuation as a treatment-planning issue: only 13 patients completed at least 12 treatments, and 8 patients dropped out of treatment without responding before completing 12 treatments.
