Relapse following bitemporal and high-dose right unilateral electroconvulsive therapy for major depression.

Autor: Jelovac A; Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin 8, Ireland., Kolshus E; Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin 8, Ireland.; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland., McLoughlin DM; Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin 8, Ireland.; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland.
Jazyk: angličtina
Zdroj: Acta psychiatrica Scandinavica [Acta Psychiatr Scand] 2021 Sep; Vol. 144 (3), pp. 218-229. Date of Electronic Publication: 2021 Jun 17.
DOI: 10.1111/acps.13331
Abstrakt: Objective: Electroconvulsive therapy (ECT) is an effective acute treatment for severe and/or medication-resistant depression but maintaining remission following completion of a course remains a clinical challenge.
Methods: EFFECT-Dep Trial (ISRCTN23577151) participants with a DSM-IV major depressive episode who met remission criteria after a randomly assigned course of twice-weekly brief-pulse bitemporal (1.5 × seizure threshold) or high-dose (6 × seizure threshold) right unilateral ECT were monitored for relapse for 12 months. In line with the pragmatic trial design, all patients received treatment-as-usual individualised pharmacotherapy during and after ECT; no remitter received continuation ECT.
Results: Of 61 remitters, 24 (39.3%) relapsed, one (1.6%) withdrew from the study while in remission and the remaining 36 (59.0%) stayed well for a year. Most relapses occurred within the first six months, resulting in a cumulative six-month relapse rate of 31.1%. In a multivariable Cox proportional hazards regression model, older age (p = 0.039) and psychotic features at pre-ECT baseline (p = 0.037) were associated with a more favourable long-term prognosis while a greater number of previous depressive episodes (p = 0.028) and bipolar II (but not bipolar I) diagnosis (p = 0.030) were associated with a worse long-term outcome. Electrode placement and medication resistance prior to ECT had no effect on relapse. Adjusting for covariates, fewer patients treated with lithium relapsed in the overall group (p = 0.008) and in the unipolar depression subgroup (p = 0.027).
Conclusion: Long-term outcome following high-dose right unilateral ECT does not differ from bitemporal ECT. Prognosis is particularly favourable in older adults, psychotic depression and patients maintained on lithium.
(© 2021 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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