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Predictors of Remission in 208 Drug-Resistant Depressive Patients Treated With Electroconvulsive Therapy

Medda, Pierpaolo MD*; Mauri, Mauro MD; Toni, Cristina MD*; Mariani, Michela Giorgi MD*; Rizzato, Salvatore MD*; Miniati, Mario MD*; De Simone, Luigi MD; Perugi, Giulio MD*†

doi: 10.1097/YCT.0000000000000119
Original Study

Objectives This study aimed to explore predictors of remission to electroconvulsive therapy (ECT) in a sample of depressive patients resistant to pharmacological treatments.

Methods Two hundred eight patients, 31 of whom had major depressive disorder, 101 had bipolar disorder II (BP II), and 76 had bipolar disorder I (BP I), diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were treated with bilateral ECT on a twice-a-week schedule. All patients included were undergoing a depressive episode, excluding patients with mixed and manic episodes. Patients were assessed before (baseline) and a week after the ECT course (final score) using the Hamilton Rating Scale for Depression-17 items (HAM-D-17), the Young Mania Rating Scale (YMRS), the Brief Psychiatric Rating Scale, and the Clinical Global Impression—Improvement (CGI-I).

Results At the end of the ECT course, 56 patients (26.9%) were considered nonresponders, and 80 patients (38.4%) were considered responders (HAM-D score of at least 50% and CGI-I subscale rating of 2, “much improved”) and 72 remitters (34.6%) (HAM-D scores ≤8 and a CGI-I subscale rating of 1). On backward stepwise logistic regression length of current episode, Bipolar Disorder and baseline YMRS total mean scores were statistically significant predictors of nonresponders versus remitters. Among the YMRS items at basal evaluation 8 (thought content), 10 (appearance), and 11 (insight), the mean scores were significantly lower in the remitters than in the responders and nonresponders.

Conclusion Major depressive disorder, short duration of the current episode, absence of psychotic symptoms, preserved insight, and adequate personal care are associated with complete remission in our sample of drug-resistant depressive patients treated with ECT.

From the *Department of Clinical and Experimental Medicine, University of Pisa, Italy; †Institute of Behavioral Science “G. De Lisio”, Carrara-Pisa, Italy and ‡Intensive Care Unit 3, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.

Received for publication September 03, 2013; accepted January 23, 2014.

Reprints: Pierpaolo Medda, MD, Clinica Psichiatrica, Dipartimento di Medicina Clinica e Sperimentale, University of Pisa, Via Roma 67, 56100, Pisa, Italy (e-mail:

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

The authors declare no other contributors to or funding sources for the present work. They also declare no previous data presentation or particular disclaimer statements.

© 2014 by Lippincott Williams & Wilkins