Patient, Treatment, and Anatomical Predictors of Outcome in Electroconvulsive Therapy

A Prospective Study

Abstract

Objectives 

Baseline predictors of effectiveness and cognitive adverse effects of electroconvulsive therapy (ECT) were prospectively examined.

Methods 

Before and after ECT, the Montgomery-Åsberg Depression Rating Scale (MADRS) and Mini Mental State Examination (MMSE) were assessed. Before ECT, a magnetic resonance imaging of the head was performed. Outcome predictors were investigated using multivariable regression analyses.

Results 

Of 83 patients (mean ± SD age, 59.2 ± 15.3 years; 39% men), 28% had a psychotic depressive disorder, 16% had a bipolar depression, 30% had had previous ECT course(s), and 66% used concomitant antipsychotics. Presence of psychotic depression (β = −0.25; P = 0.04) and having had previous ECT (β = −0.35; P = 0.003) predicted lower post-ECT MADRS score. Baseline magnetic resonance imaging characteristics were not predictive of post-ECT MADRS and MMSE scores. The use of concomitant antipsychotics predicted a lower post-ECT MMSE score (β = −0.21; P = 0.02), whereas the presence of bipolar depression at baseline predicted higher post-ECT MMSE score (β = 0.23; P = 0.01). The post-ECT MADRS score seemed to be a confounder for the post-ECT MMSE score (β = −0.20; P = 0.02).

Conclusions 

Effectiveness of ECT was better in the patients with a baseline psychotic depression and those who had had ECT before. Cognitive outcome was better in the patients with baseline bipolar depression but worse in those who used antipsychotics during ECT and those who showed more persistent depressive symptoms after ECT.