You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Predictors of Response to Electroconvulsive Therapy Obtained Using the Three-Factor Structure of the Montgomery and Åsberg Depression Rating Scale for Treatment-Resistant Depressed Patients

Okazaki, Mioto MD; Tominaga, Keiichiro MD, PhD; Higuchi, Hisashi MD, PhD; Utagawa, Itaru MD, PhD; Nakamura, Etsuko MD, PhD; Noguchi, Miwa MD; Itaya, Mikiko MD; Hashimoto, Chiaki MD; Yamaguchi, Noboru MD, PhD

Journal of ECT:
doi: 10.1097/YCT.0b013e3181b00f32
Original Studies

Objective: Electroconvulsive therapy (ECT) is one of the most effective treatments for refractory major depressive disorder (MDD). Although studies have examined different predictors of a positive response to ECT, predictors based on symptoms listed on a depression rating scale have not been studied.

Methods: This study included 24 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for MDD or bipolar disorder with current major depressive episode. All subjects had a score of 21 or higher on the Montgomery and Åsberg Depression Rating Scale (MADRS). The 3-factor model of MADRS was used for analysis: factor 1 (dysphoria) was defined by 3 items, factor 2 (retardation) was defined by 4 items, and factor 3 (vegetative symptoms) was defined by 3 items. Electroconvulsive therapy was performed 2 times a week for a total of 6 sessions using the Thymatron System IV device (Somatics, Inc., Lake Bluff, Ill) with the brief-pulse technique. A clinical response was defined as a 50% or greater decrease on the pretreatment total MADRS score.

Results: The mean factor 1 score of responders (n = 17) at pretreatment was significantly higher than that of the nonresponders (n = 7). Furthermore, a significant difference in mean factor 3 scores between responders and nonresponders was observed 1 week after the 6 ECT sessions were complete, indicating a lag in response time. No significant differences were observed in age, number of previous episodes, and duration of current episodes between the responders and nonresponders.

Conclusions: This study suggests that a high factor 1 MADRS score at pretreatment was a good predictor of response to ECT in patients with treatment-resistant MDD.

Author Information

From the Department of Neuropsychiatry, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Japan.

Received for publication March 18, 2009; accepted May 21, 2009.

Reprints: Mioto Okazaki, MD, Department of Neuropsychiatry, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City 216-8511, Japan (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.