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Patient, Treatment, and Anatomical Predictors of Outcome in Electroconvulsive Therapy: A Prospective Study

van Waarde, Jeroen A. MD*; van Oudheusden, Lucas J.B. MD*; Heslinga, Oscar Büno BN*; Verwey, Bastiaan MD, PhD*; van der Mast, Rose C. MD, PhD; Giltay, Erik MD, PhD

doi: 10.1097/YCT.0b013e31827e0d02
Original Studies

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.

From the *Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands; and †Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.

Received for publication August 20, 2012; accepted November 14, 2012.

Reprints: Jeroen A. van Waarde, MD, Department of Psychiatry, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

© 2013 by Lippincott Williams & Wilkins