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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    • "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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    ABSTRACT: Electroconvulsive therapy (ECT) is the longest standing psychiatric treatment available and has unequivocal benefit in severe depression. However this treatment comes with a number of side effects such as memory impairment. On the other hand, Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new form of treatment which has been shown to be efficacious in patients suffering from a number of psychopathologies, including severe depression, with few reported side effects. Due to its potential therapeutic efficacy and lack of side effects, rTMS has gained traction in the treatment of depression, with a number of authors keen to see it take over from ECT. However, it is not clear whether rTMS represents a therapeutic alternative to ECT. This meta-analysis will therefore compare the “gold standard” treatment for severe depression, with the relatively new but promising rTMS. A literature search will be performed with the intention to include all randomised clinical trials. The null hypothesis is that there is no difference in the antidepressant efficacy between the two types of treatment modalities. Statistical analysis of Hamilton Depression Rating Scale (HDRS) scores will be performed.
    Depression research and treatment 07/2014; 2014. DOI:10.1155/2014/135049
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    • "One of the more intense therapeutic treatments for severe psychiatric disorders, especially depression, is electroconvulsive therapy (ECT) [112]. In the 1940s and 50s, ECT was used in extreme cases in humans when patients did not respond to other treatments [112, 113]. "
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    Neural Plasticity 12/2012; 2012:854285. DOI:10.1155/2012/854285 · 3.58 Impact Factor
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    • "Conceptually, MST is a hybrid of TMS and electroconvulsive therapy (ECT). The former neurotherapeutic modality produces an approximate 15% remission rate with minimal adverse effects (George et al., 2010; Janicak et al., 2008), whereas the latter is one of the strongest antidepressants with an approximate 87% remission rate, but with moderate adverse effects (Husain et al., 2004; Semkovska & McLoughlin, 2010). Thus, the development of MST aims to combine the optimal antidepressant effects of ECT with the minimal adverse effect profi le of TMS (Lisanby, 2002). "
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    ABSTRACT: Magnetic seizure therapy (MST) is a novel neurotherapeutic intervention in development for the treatment of major affective disorders. Like other neurotherapeutic strategies such as electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), a primary interest will be to monitor the associated neurocognitive effects. Thus, the purpose of this systematic review was to synthesize the available data on the neurocognitive effects of MST. The authors performed two independent literature searches with the following terms terms: MST, magnetic, magnetic seizure therapy, depression, neurocognition, cognitive, preclinical. We included in this review a total of eleven articles that mentioned MST and neurocognition in the abstract. The articles were divided into three methodological domains that included virtual computer simulations, preclinical studies, and clinical investigations. Collectively, the available evidence suggests MST has little to no adverse cognitive effects. Specifically, virtual computer simulations found the magnetic field was localized to grey matter, and preclinical studies found no neurocortical or neurocognitive sequelae. Clinical investigations found MST to be associated with rapid reorientation and intact anterograde and retrograde memory. Future investigations using translational methods are warranted to confirm these findings and to further determine the effects of MST on neurocognitive functions.
    International Review of Psychiatry 10/2011; 23(5):413-23. DOI:10.3109/09540261.2011.623687 · 1.80 Impact Factor
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