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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

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.

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.