Speed of Response and Remission in Major Depressive Disorder With Acute Electroconvulsive Therapy (ECT)

Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/2004; 65(4):485-91. DOI: 10.4088/JCP.v65n0406
Source: PubMed


Remission of illness in patients with major depressive disorder (MDD) is achieved in less than half of patients initially treated with medication. Electroconvulsive therapy (ECT) is another treatment option. We report the speed of response and remission rates in a cohort of depressed patients who received a course of acute-phase ECT in the initial phase of an ongoing multicenter randomized trial of continuation ECT versus pharmacotherapy.
Patients with MDD according to DSM-IV criteria received bilateral ECT 3 times weekly. Prior to each treatment, a 24-item Hamilton Rating Scale for Depression (HAM-D-24) score was obtained by a clinical rater. Sustained response was defined as a > or = 50% reduction in baseline HAM-D-24 score for at least 2 and all subsequent measurement occasions. Remission was defined as HAM-D-24 scores of < or = 10 for at least the last 2 consecutive assessments. Data were collected from May 1997 through November 2000.
Of the 253 patients who entered the study, 86% (N = 217) completed the acute course of ECT. Sustained response occurred in 79% of the sample, and remission occurred in 75% of the sample (N = 253); 34% (85/253) of patients achieved remission at or before ECT #6 (week 2), and 65% (164/253) achieved remission at or before ECT #10 (weeks 3-4). Over half (54%; 136/253) had an initial first response by ECT #3 (end of week 1).
ECT was associated with rapid response and remission in a high percentage of patients. ECT warrants early consideration in treatment algorithms for patients with MDD.

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Available from: Shawn M Mcclintock, May 15, 2015
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    • "Although effective pharmacological and psychosocial interventions exist, there is a considerable lag before clinically relevant efficacy, which further increases suicide risk and illness burden (Trivedi et al. 2006), particularly during the first days after starting antidepressants (Jick et al. 2004). Electroconvulsive therapy (ECT) has more rapid antidepressant effects than standard pharmacotherapy (Husain et al. 2004), but its invasive nature and adverse cognitive effects make it usually a last treatment choice for MDD (Pagnin et al. 2004). "
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    • "This confirmed the findings by the UK ECT Review Group [2] which had found that ECT is an " effective short-term treatment for depression and is probably more effective than drug therapy. " The consortium for Research in ECT [3] also found a strong positive effect for ECT, with remission rates of 75% after the first two weeks of use, in patients suffering from acute depressive illness. In a recent study by Kellner et al. [4] 200 patients diagnosed with unipolar depression showed better remission rates after bilateral ETC when compared to the control group on Nortriptyline and Lithium. "
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