How-To Guides
2 guidesHow to Monitor Community ECT Response in Severe Depression
How should clinicians track depression, anxiety, and cognition during an acute community ECT course for severe treatment-resistant depression?
How to Screen Anxiety Before ECT for Depression Response Risk
How can clinicians use baseline anxiety assessment to identify patients with depression who may be less likely to respond to ECT?
Frequently Asked Questions
13 questions-
In this community ECT clinic, 54.3% of patients had a depression response and 31.4% achieved remission on the PHQ-9. Specifically, 19 of 35 patients met response criteria, defined as at least a 50% reduction in PHQ-9 score, and 11 of 35 met remission criteria, defined as PHQ-9 score less than 5. Using secondary measures, 23.1% remitted on the HAMD-17.
-
The sample was highly treatment resistant before ECT. Among the 35 included patients, the mean number of documented antidepressant medication trials was 5.3 (SD=2.4), and patients were required to have severe depressive symptoms at baseline, with an initial PHQ-9 score of 20 or higher.
-
Yes. Improvement in anxiety symptoms was significantly associated with depression response during the ECT course. Logistic regression showed that improvement in GAD-7 scores was associated with PHQ-9 response (OR=1.407, 95% CI, 1.113-1.779, P=.004) and with HAMD-17 response (OR=1.281, 95% CI, 1.033-1.588, P=.024). In addition, 84.2% of patients who responded on the PHQ-9 also showed an anxiety response on the GAD-7.
-
Yes. Patients with initial severe anxiety, defined as GAD-7 score 15 or higher, were less likely to show depression response on the PHQ-9 than patients without severe anxiety. The response rates were 41.7% versus 81.8%, respectively, and this difference was statistically significant (c7b2b9 [N=35]=4.900, P=.027).
-
No. In this study, initial PHQ-9 score did not predict PHQ-9 response to ECT. The odds ratio was 1.062 (95% CI, 0.780-1.446; P=.701), which the authors interpreted as suggesting that, within this severely depressed group, baseline depression severity was not predictive of treatment response.
-
Not when analyzed as the initial GAD-7 score itself. Initial GAD-7 scores did not predict PHQ-9 response rates, with an odds ratio of 0.950 (95% CI, 0.812-1.112; P=.523). However, patients categorized as having severe anxiety at baseline, defined as GAD-7 of 15 or higher, were less likely to respond than other patients.
-
No statistically significant difference was found based on initial electrode placement. Among patients who started with bilateral ECT, 50.0% responded on the PHQ-9, compared with 61.5% of those who started with right unilateral treatment (c7b2b9 [N=35]=0.44, P=.51).
-
No significant difference was found. Patients who started ECT while hospitalized had a PHQ-9 response rate of 67.6%, compared with 32.4% for those who started as outpatients, but this difference was not statistically significant (c7b2b9 [N=34]=1.79, P=.18).
-
No significant age-related difference was found in this study. PHQ-9 response occurred in 42.9% of patients aged 65 years and older versus 57.1% of patients younger than 65 years (c7b2b9 [N=35]=0.461, P=.497).
-
Possibly. Among patients who completed the MoCA, those with a baseline score below 22 had lower response rates than those with scores of 22 or higher. On the PHQ-9, response was 16.7% for MoCA below 22 versus 56.0% for MoCA 22 or higher, a difference that approached statistical significance (c7b2b9 [N=31]=3.0, P=.083). On the HAMD-17, response was 0% versus 57.1%, respectively, and that difference was statistically significant (c7b2b9 [N=25]=4.40, P=.036).
-
Only 13 of 35 patients completed at least 12 treatments. The mean number of treatments was 9.3 (SD=3.0). Of the 21 patients who did not complete 12 treatments, 13 responded and 9 remitted, while 8 patients dropped out without responding before completing 12 treatments.
-
This was a retrospective chart review of 35 adults treated with an acute ECT series at a community clinic from March 1, 2014, to March 9, 2015. Patients had major depressive disorder or depressive disorder NOS, were 18 years or older, and had baseline PHQ-9 scores of 20 or higher; patients with bipolar disorder, schizophrenia, schizoaffective disorder, dementia, recent ECT within 6 months, or insufficient data were excluded. Because the study was retrospective, small, and treatment delivery was not fully standardized, the findings are useful for describing real-world community outcomes but are limited for making strong causal or comparative conclusions.
-
The main limitations were a small sample size, substantial early discontinuation, and lack of standardization in how ECT was delivered. Only 35 patients were included, only 13 completed 12 sessions, reasons for early discontinuation were missing, and psychiatrists may have differed in treatment titration and in choosing bilateral versus right unilateral electrode placement. The authors also noted that the small sample limited power to detect effects of factors such as electrode placement, age, and sex.
