Key Takeaways
Extended Takeaways
- This community sample was highly treatment resistant before ECT, with a mean of 5.3 (SD=2.4) antidepressant medication trials, which likely helps explain why outcomes were less robust than rates commonly cited from controlled trials.
- Early attrition may be a major practical barrier to benefit: only 13 patients completed at least 12 treatments, and 8 patients dropped out of treatment without responding before completing 12 treatments.
- Baseline cognitive impairment may signal lower likelihood of benefit. Only 16.7% of patients with a MoCA score <22 responded on the PHQ-9 versus 56.0% with a score ≥22, and HAMD-17 response was 0% versus 57.1%.
- Initial depression severity did not help identify likely responders in this severe cohort, as initial PHQ-9 scores were not associated with PHQ-9 response (OR = 1.062, 95% CI, 0.780–1.446, P = .701).
- Starting treatment with bilateral versus right unilateral electrode placement was not associated with a significant difference in PHQ-9 response in this chart review, with response rates of 50.0% and 61.5%, respectively.
- Treatment setting and age also did not significantly separate responders from nonresponders: PHQ-9 response did not differ for patients starting ECT as inpatients versus outpatients (67.6% vs 32.4%, P = .18) or for those age 65 years and older versus younger than 65 years (42.9% vs 57.1%, P = .497).
