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Leuchter MK, Citrenbaum C, Wilson AC, Tibbe TD, Jackson NJ, Krantz DE, Wilke SA, Corlier J, Strouse TB, Hoftman GD, Tadayonnejad R, Koek RJ, Slan AR, Ginder ND, Distler MG, Artin H, Lee JH, Adelekun AE, Leuchter AF. A comparison of self- and observer-rated scales for detecting clinical improvement during repetitive transcranial stimulation (rTMS) treatment of depression. Psychiatry Res 2023; 330:115608. [PMID: 37984281 DOI: 10.1016/j.psychres.2023.115608] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Clinical outcomes of repetitive Transcranial Magnetic Stimulation (rTMS) for treatment of Major Depressive Disorder (MDD) vary widely, and no single mood rating scale is standard for assessing rTMS outcomes. This study of 708 subjects undergoing clinical rTMS compared the performance of four scales in measuring symptom change during rTMS treatment. Self-report and observer ratings were examined weekly with the Inventory of Depressive Symptomatology 30-item (IDS), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item (POMS), and Hamilton Depression Rating Scale 17-item (HDRS). While all scales were correlated and detected significant improvement, the degree of improvement over time as well as response (33-50%) and remission (20-24%) rates varied significantly. Higher baseline severity was associated with lower likelihood of remission, and greater improvement by sessions 5 and 10 predicted response across all scales. Use of only a single scale to assess outcome conferred 14-36% risk of failing to detect response/remission indicated by another scale. The PHQ was most likely to indicate improvement and least likely to miss response or remission. These findings indicate that assessment of symptom burden during rTMS treatment may be most accurately assessed through use of multiple instruments.
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Affiliation(s)
- Michael K Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA.
| | - Cole Citrenbaum
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | | | - Tristan D Tibbe
- Department of Psychology, University of California, Los Angeles, CA 90024, USA; Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA
| | - Nicholas J Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA
| | - David E Krantz
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Scott A Wilke
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Juliana Corlier
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Thomas B Strouse
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Gil D Hoftman
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Reza Tadayonnejad
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA; Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Ralph J Koek
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Aaron R Slan
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Nathaniel D Ginder
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Margaret G Distler
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Hewa Artin
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - John H Lee
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Adesewa E Adelekun
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
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2
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Tsai HJ, Yang WC, Tsai SJ, Lin CH, Yang AC. Right-side frontal-central cortical hyperactivation before the treatment predicts outcomes of antidepressant and electroconvulsive therapy responsivity in major depressive disorder. J Psychiatr Res 2023; 161:377-385. [PMID: 37012197 DOI: 10.1016/j.jpsychires.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
Major depressive disorder places a great burden on healthcare resources worldwide. Antidepressants are the first-line treatment for major depressive disorder, but if patients don't respond adequately, brain stimulation therapy may be needed as second-line treatment. Digital phenotyping in patients with major depressive disorder will aid in the timely prediction of treatment effectiveness. This study explored electroencephalographic (EEG) signatures that diversify depression treatment responsivity, including antidepressant administration or brain stimulation therapy. Resting-state, pre-treatment EEG sequences from depressive patients who received fluoxetine treatment (n = 55; 26 remitters and 29 poor responders) or electroconvulsive therapy (ECT, n = 58; 36 remitters and 22 nonremitters) were recorded on 19 channels. Twenty-nine EEG segments were obtained from each patient per recording electrode. Power spectral analysis was conducted for feature extraction and showed the highest predictive accuracy for fluoxetine or ECT outcomes. Both occurred with beta-band oscillations within right-side frontal-central (F1-score = 0.9437) or prefrontal areas of the brain (F1-score = 0.9416), respectively. Significantly higher beta-band power was observed among patients who lacked adequate treatment response than the remitters, specifically at 19.2 Hz or 24.5 Hz for fluoxetine administration or ECT outcome, respectively. Our findings indicated that pre-treatment, right-side cortical hyperactivation is associated with poor outcomes of antidepressant-based or ECT-based treatment in major depression. Whether depression treatment response rates can be improved by reducing the high-frequency EEG power in corresponding areas of the brain to provide a protective effect against depression recurrence warrants further study.
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Affiliation(s)
- Hsin-Jung Tsai
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Digital Medicine and Smart Healthcare Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Cheng Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Shih-Jen Tsai
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
| | - Albert C Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Digital Medicine and Smart Healthcare Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
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3
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The impact of the number of electroconvulsive therapy sessions on relapse in major depressive disorder. Int J Psychiatry Clin Pract 2022; 26:376-380. [PMID: 35152820 DOI: 10.1080/13651501.2022.2035771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective treatment of major depressive disorder (MDD). However, high relapse rates after ECT represent clinical problems. To date, influence of number of ECT sessions on relapse rate remains to be elucidated. We evaluated associations between number of ECT sessions and relapse rate. METHODS This retrospective review collected clinical data of 53 patients with MDD who received ECT. They underwent a 1-year follow-up after their last ECT session. We performed survival analysis to evaluate associations between number of ECT sessions and time until rehospitalisation or suicide. RESULTS The patients were divided into a higher number of ECT group (≧8 sessions) and lower number of ECT group (<8 sessions). No significant difference was found regarding the patients' clinical and demographic data. Survival analysis using log-rank test revealed that the cumulative survival rate in the higher number of ECT group (79%) was higher compared with the lower number of ECT group (49%) (p = 0.042). CONCLUSION Patients who underwent a higher number of ECT had improved survival rate compared with those who received a lower number. Therefore, additional sessions might be necessary, even in patients who achieved remission within seven ECT sessions, to prevent relapse.Key pointsHigh rate of relapse after ECT is a key problem.Impact of the Number of ECT sessions on relapse remains to be elucidated.In the present study, the patients with MDD who underwent eight or more sessions of ECT showed significant lower relapse rate compared with those who received less than eight sessions.
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Zheng W, He M, Gu LM, Lao GH, Wang DF, Mai JX, Wu HW, Nie S, Huang X. Early improvement as a predictor of final remission in patients with treatment-resistant depression receiving electroconvulsive therapy with ketofol anesthesia. J Affect Disord 2022; 310:223-227. [PMID: 35550826 DOI: 10.1016/j.jad.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/20/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine whether early symptom improvement can predict eventual remission following electroconvulsive therapy (ECT) with ketamine plus propofol (ketofol) anesthesia in patients with treatment-resistant depression (TRD). METHODS Thirty Han Chinese subjects suffering from TRD were administered ketofol anesthesia during ECT. Remission was defined as a score of ≤7 on the 17-item Hamilton Depression Rating Scale (HAMD-17). Receiver operating characteristic (ROC) curves were applied to identify the number of ECT sessions (i.e., 1, 2, 3, or 4 ECT sessions) that had the best discriminative capacity for eventual remission. The best definition of early improvement to predict final remission was determined by using the Youden index. RESULTS Of the 30 patients with TRD, 16 (53.3%) and 30 (100%) were classified as remitters and responders, respectively. A 45% reduction in the HAMD-17 score after 3 ECT sessions was the optimum definition of early improvement in the prediction of eventual remission, with relatively good sensitivity (88%) and specificity (93%). Patients with than without early improvement had a greater possibility of achieving favorable ECT outcomes. CONCLUSION Final remission of TRD following ECT with ketofol anesthesia appeared to be predicted by early improvement, as indicated by a 45% reduction in HAMD-17 score after 3 ECT sessions.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mei He
- Nanning Fifth People's Hospital, Nanning, China
| | - Li-Mei Gu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guo-Hui Lao
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dan-Feng Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian-Xin Mai
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hua-Wang Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sha Nie
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Xiong Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
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5
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Spitz NA, Pace BD, Ten Eyck P, Trapp NT. Early Improvement Predicts Clinical Outcomes Similarly in 10 Hz rTMS and iTBS Therapy for Depression. Front Psychiatry 2022; 13:863225. [PMID: 35633811 PMCID: PMC9130587 DOI: 10.3389/fpsyt.2022.863225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prior studies have demonstrated that early treatment response with transcranial magnetic stimulation (TMS) can predict overall response, yet none have directly compared that predictive capacity between intermittent theta-burst stimulation (iTBS) and 10 Hz repetitive transcranial magnetic stimulation (rTMS) for depression. Our study sought to test the hypothesis that early clinical improvement could predict ultimate treatment response in both iTBS and 10 Hz rTMS patient groups and that there would not be significant differences between the modalities. Methods We retrospectively evaluated response to treatment in 105 participants with depression that received 10 Hz rTMS (n = 68) and iTBS (n = 37) to the dorsolateral prefrontal cortex (DLPFC). Percent changes from baseline to treatment 10 (t10), and to final treatment (tf), were used to calculate confusion matrices including negative predictive value (NPV). Treatment non-response was defined as <50% reduction in PHQ-9 scores according to literature, and population, data-driven non-response was defined as <40% for 10 Hz and <45% for iTBS. Results For both modalities, the NPV related to degree of improvement at t10. NPV for 10 Hz was 80%, 63% and 46% at t10 in those who failed to improve >20, >10, and >0% respectively; while iTBS NPV rates were 65, 50, and 35%. There were not significant differences between protocols at any t10 cut-off assessed, whether research defined 50% improvement as response or data driven kernel density estimates (p = 0.22-0.44). Conclusion Patients who fail to achieve >20% improvement by t10 with both 10 Hz rTMS and iTBS therapies have ~70% chance of non-response to treatment. With no significant differences between predictive capacities, identifying patients at-risk for non-response affords psychiatrists greater opportunity to adapt treatment strategies.
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Affiliation(s)
- Nathen A. Spitz
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Benjamin D. Pace
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, United States
| | - Nicholas T. Trapp
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, United States
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6
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Mirman AM, Corlier J, Wilson AC, Tadayonnejad R, Marder KG, Pleman CM, Krantz DE, Wilke SA, Levitt JG, Ginder ND, Ojha R, Daskalakis ZJ, Leuchter AF, Lee JC. Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder. Depress Anxiety 2022; 39:123-133. [PMID: 34990046 DOI: 10.1002/da.23237] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/06/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptoms of major depressive disorder (MDD) are reported to change early in treatment with repetitive transcranial magnetic stimulation (rTMS). We evaluated early changes in sleep, anxiety, and mood as predictors of nonresponse to rTMS treatment. METHODS Three hundred twenty-nine subjects with nonpsychotic MDD completed a 6-week course of rTMS treatment. Subjects were stratified by the severity of their baseline depression, and had their overall depressive symptoms recorded every week of treatment. We evaluated lack of improvement in sleep, anxiety, and mood symptoms after 1 and 2 weeks as potential predictors of eventual nonresponse, defined as <50% improvement in compositive depressive symptoms after 6 weeks. This was measured as negative predictive value (NPV; the likelihood that lack of early symptom improvement accurately predicted eventual treatment nonresponse). RESULTS Subjects with severe or very severe baseline depression achieving <20% improvement in mood at 1 week were correctly predicted as nonresponders with NPVs largely >90%. At 2 weeks, subjects with very severe baseline depression who failed to demonstrate any improvement in mood were all nonresponders. Lack of improvement in sleep at 2 weeks was also a significant predictor. CONCLUSIONS Identifying a lack of early mood improvement is a practical and robust method to predict rTMS nonresponse. This suggests a treatment protocol change may be indicated in patients with more severe baseline depression showing minimal early mood improvement.
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Affiliation(s)
- Alex M Mirman
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Juliana Corlier
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Andrew C Wilson
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Reza Tadayonnejad
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA
| | - Katharine G Marder
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christopher M Pleman
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David E Krantz
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Scott A Wilke
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer G Levitt
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nathaniel D Ginder
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Rashi Ojha
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Andrew F Leuchter
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jonathan C Lee
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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7
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Wang X, Qin J, Zhu R, Zhang S, Tian S, Sun Y, Wang Q, Zhao P, Tang H, Wang L, Si T, Yao Z, Lu Q. Predicting treatment selections for individuals with major depressive disorder according to functional connectivity subgroups. Brain Connect 2021; 12:699-710. [PMID: 34913731 DOI: 10.1089/brain.2021.0153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a highly prevalent and disabling disease. Currently, patients' treatment choices depend on their clinical symptoms observed by clinicians, which are subjective. Rich evidence suggests that different functional networks' dysfunctions correspond to different intervention preferences. Here, we aimed to develop a prediction model based on data-driven subgroups to provide treatment recommendations. METHODS All 630 participants enrolled from four sites underwent functional magnetic resonances imaging at baseline. In the discovery dataset (n=228), we firstly identified MDD subgroups by the hierarchical clustering method using the canonical variates of resting-state functional connectivity (FC) through canonical correlation analyses. The demographic, symptom improvement and FC were compared among subgroups. The preference intervention for each subgroup was also determined. Next, we predicted the individual treatment strategy. Specifically, a patient was assigned into predefined subgroups based on FC similarities and then his/her treatment strategy was determined by the subgroups' preferred interventions. RESULTS Three subgroups with specific treatment recommendations were emerged including: (1) a selective serotonin reuptake inhibitors-oriented subgroup with early improvements in working and activities. (2) a stimulation-oriented subgroup with more alleviation in suicide. (3) a selective serotonin noradrenaline reuptake inhibitors-oriented subgroup with more alleviation in hypochondriasis. Through cross-dataset testing respectively conducted on three testing datasets, results showed an overall accuracy of 72.83%. CONCLUSIONS Our works revealed the correspondences between subgroups and their treatment preferences and predicted individual treatment strategy based on such correspondences. Our model has the potential to support psychiatrists in early clinical decision making for better treatment outcomes.
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Affiliation(s)
- Xinyi Wang
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, Jiangsu, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
| | - Jiaolong Qin
- Nanjing University of Science and Technology, 12436, The Key Laboratory of Intelligent Perception and Systems for High-Dimensional Information of Ministry of Education, School of Computer Science and Engineering, Nanjing, Jiangsu, China;
| | - Rongxin Zhu
- Nanjing Medical University Affiliated Brain Hospital, 56647, Department of Psychiatry, Nanjing, Jiangsu, China;
| | - Siqi Zhang
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
| | - Shui Tian
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, Jiangsu, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
| | - Yurong Sun
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, Jiangsu, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
| | - Qiang Wang
- Nanjing Drum Tower Hospital, 66506, Nanjing, Jiangsu, China;
| | - Peng Zhao
- Nanjing Drum Tower Hospital, 66506, Nanjing, Jiangsu, China;
| | - Hao Tang
- Nanjing Medical University Affiliated Brain Hospital, 56647, Department of Psychiatry, Nanjing, Jiangsu, China;
| | - Li Wang
- Peking University Institute of Mental Health, 74577, Beijing, Beijing, China;
| | - Tianmei Si
- Peking University Institute of Mental Health, 74577, Beijing, Beijing, China;
| | - Zhijian Yao
- Nanjing Medical University Affiliated Brain Hospital, 56647, Department of psychiatry, Nanjing, Jiangsu, China.,Nanjing Brain Hospital, 56647, Medical School of Nanjing University, Nanjing, Nanjing, China;
| | - Qing Lu
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
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8
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Ferrier IN, Waite J, Sivasanker V. Recent advances in electroconvulsive therapy and physical treatments for depression. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SUMMARYThis article gives an update for practitioners on recent developments in the use of electroconvulsive therapy (ECT) and related treatment modalities in the contemporary treatment of depression in the UK. Details are provided on new information on the efficacy and side-effects of ECT both in research studies and in the real world, together with recent research on ECT's mode of delivery. There is a focus on the safe administration of ECT in clinical practice. An update on the regulatory framework for ECT in the UK is provided, together with up-to-date information on the legal situation regarding its prescription. Finally, brief summaries of the current position for other neuromodulatory treatment modalities are given.
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Zheng W, Jiang ML, He HB, Li RP, Li QL, Zhang CP, Zhou SM, Yan S, Ning YP, Huang X. A Preliminary Study of Adjunctive Nonconvulsive Electrotherapy for Treatment-Refractory Depression. Psychiatr Q 2021; 92:311-320. [PMID: 32661940 DOI: 10.1007/s11126-020-09798-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Nonconvulsive electrotherapy (NET) defined as electrical brain stimulation administered like standard electroconvulsive therapy (ECT), but below seizure threshold, could be effective for patients with treatment-refractory depression (TRD) with fewer adverse neurocognitive outcomes. However, there is a lack of studies in Chinese patients with TRD. Thus, this study was conducted to examine the efficacy and safety of adjunctive NET for Chinese patients with TRD. Twenty TRD patients were enrolled and underwent six NET treatments. Depressive symptoms, response, and remission were assessed with the 17-item Hamilton Depression Rating Scale (HAMD-17) at baseline and after 1, 3, and 6 NET treatments. Neurocognitive function was assessed by the Wisconsin Card Sorting Test (WCST) at baseline and after the completion of six NET treatments. Mean HAMD-17 scores declined significantly from 26.2 to 10.4 (p < 0.001) after post-NET. The rates of response and remission were 60.0% (95% CI: 36.5-83.5) and 10.0% (95% CI: 0-24.4), respectively. Neurocognitive performance improved following a course of NET. No significant association was found between changes in depressive symptoms and baseline neurocognitive function. Adjunctive NET appeared to be effective for patients with TRD, without adverse neurocognitive effects. Randomized controlled studies were warranted to confirm these findings.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Miao-Ling Jiang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Hong-Bo He
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ri-Peng Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Qi-Long Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chun-Ping Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Su-Miao Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Su Yan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China. .,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Xiong Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
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10
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Chen F, Sidhom E, Yang S, Ruiz-Mendoza E, Essem J. Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder. BMC Psychiatry 2021; 21:50. [PMID: 33478427 PMCID: PMC7818214 DOI: 10.1186/s12888-021-03053-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Major depressive disorder and associated mood syndromes are amongst the most common psychiatric disorders. To date, electroconvulsive therapy (ECT) is considered the most effective short-term treatment for patients with severe or treatment-resistant depression. In clinical practice, there is considerable variation in the ECT dosing schedule, with the number of sessions typically ranging from 6 to 12, with early antidepressant effects being predictive of increased positive outcomes. We describe here an unusual case of a female patient with severe depression who did not respond to ECT until the 11th session, after which she had shown a drastic improvement in her mental state. CASE PRESENTATION A 75-year-old female presented to the old age psychiatry inpatient unit with new onset dysphoric mood, anhedonia, and severe negativity. She scored 23 on the 17-item Hamilton Rating Scale for Depression (HAM-D), and was rated 6 on Clinical Global Impression severity (CGIS) by the responsible clinician. She suffered from post-natal depression fifty years ago and was successfully treated with ECT. She was therefore initiated on a course of ECT treatment. Her condition initially deteriorated, displaying features of catatonia and psychosis, unresponsive to ECT treatment or concurrent psychotropic medications. After 11th ECT session, she started to show signs of clinical improvement and returned close to her baseline mental state after a total of 17 ECT sessions. She remained well 3 months post-treatment, scoring 4 on HAM-D, Clinical Global Improvement or change (CGI-C) rated as 1 (very much improved). The diagnosis was ICD-10 F32.3 severe depressive episode with psychotic symptoms. CONCLUSIONS we describe here an unusual case of delayed response to electroconvulsive therapy in the treatment of severe depressive disorder. Studies have shown the number of acute ECT treatments to be highly variable, affected by a number of factors including treatment frequency, condition treated and its severity, the ECT technical parameters, as well as concurrent use of pharmacological treatment. This may call for re-consideration of the current ECT treatment guidelines, requiring more research to help stratify and standardize the treatment regime.
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Affiliation(s)
- Fangyue Chen
- Peterborough City Hospital, Bretton Gate, Peterborough, UK.
| | - Emad Sidhom
- grid.5335.00000000121885934Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Sharon Yang
- grid.417250.50000 0004 0398 9782Older People’s Mental Health, Cavell Centre, Edith Cavell Hospital, Peterborough, UK
| | - Eladia Ruiz-Mendoza
- grid.417250.50000 0004 0398 9782Peterborough City Hospital, Bretton Gate, Peterborough, UK
| | - Julius Essem
- grid.417250.50000 0004 0398 9782Older People’s Mental Health, Cavell Centre, Edith Cavell Hospital, Peterborough, UK
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11
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Abstract
OBJECTIVE Resolution of suicidal ideation for patients with major depressive disorder is an important public health challenge. We aimed to determine whether electroconvulsive therapy (ECT) or fluoxetine was more efficacious in resolving suicidal ideation and achieving long-term protective effect against suicidality. METHODS The data used in this study were drawn from 2 open-label trials for major depressive disorder patients receiving ECT or fluoxetine for acute treatment, together with continuation medication in the 12-week follow-up. We compared the effects of ECT and fluoxetine on suicidal ideation as scored by the suicide item on the 17-item Hamilton Rating Scale for Depression. RESULTS The differences between these 2 groups in time to resolution of suicidal ideation (suicide item = 0) in the acute treatment period, and time to relapse of suicidal ideation (suicide item score ≥1 or rehospitalization for suicidality) in the follow-up period were analyzed. Electroconvulsive therapy-treated patients (n = 111) had significantly shorter time to resolution of suicidal ideation than fluoxetine-treated patients (n = 114) during acute treatment. However, there was no statistically significant difference in time to relapse of suicidal ideation between 2 groups in the 12-week follow-up period. CONCLUSIONS Electroconvulsive therapy was superior to fluoxetine in resolving suicidal ideation during acute treatment. Therefore, ECT should be an early consideration for suicidal patients. Electroconvulsive therapy and fluoxetine were equally effective in preventing recurrence of suicidal ideation in the 12-week follow-up period. Routine suicide risk assessments from hospital care to outpatient care are required to identify any signs of suicidal relapse.
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12
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Mondino M, Szekely D, Bubrovszky M, Bulteau S, Downar J, Poulet E, Brunelin J. Predicting treatment response to 1Hz rTMS using early self-rated clinical changes in major depression. Brain Stimul 2020; 13:1603-1605. [PMID: 33065360 DOI: 10.1016/j.brs.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Marine Mondino
- Centre Hospitalier Le Vinatier, F69500, Bron, France; INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 Team, F-69000 Lyon, France; Lyon University, Université Lyon 1, F-69100, Villeurbanne, France.
| | - David Szekely
- Department of Psychiatry, Centre Hospitalier Princesse-Grace, 98000 Monaco.
| | - Maxime Bubrovszky
- Secteur de Psychiatrie Générale 59G11, EPSM de l'Agglomération Lilloise, BP 4 - 59871 Saint André Lez Lille, France.
| | - Samuel Bulteau
- UMR 1246 SPHERE, University of Nantes, University of Tours, INSERM, Nantes, France; CHU Nantes, Department of Addictology and Psychiatry, F 44000 Nantes, France.
| | - Jonathan Downar
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Emmanuel Poulet
- Centre Hospitalier Le Vinatier, F69500, Bron, France; INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 Team, F-69000 Lyon, France; Lyon University, Université Lyon 1, F-69100, Villeurbanne, France; Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices Civils de Lyon, F-69000, Lyon, France.
| | - Jerome Brunelin
- Centre Hospitalier Le Vinatier, F69500, Bron, France; INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 Team, F-69000 Lyon, France; Lyon University, Université Lyon 1, F-69100, Villeurbanne, France.
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13
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Abstract
Headache is a common side effect of electroconvulsive therapy (ECT), but reports on its incidence vary widely. A broad array of treatment regimens have been proposed in the literature. The pathophysiology of post-ECT headache is unclear but a vascular origin has been suggested. A systematic literature search was executed in PubMed and Embase to identify relevant articles. Articles were screened on title, abstract, and full text according to predefined inclusion and exclusion criteria. Study characteristics and results concerning the incidence of post-ECT headache were extracted, and a weighted mean incidence was calculated. Forty-seven relevant articles were found, of which 36 reported on the incidence of post-ECT headache in patients and 9 on the incidence in sessions. The incidence of post-ECT headache varied greatly in the literature. The weighted mean incidence in patients was 32.8%, as 786 of a total population of 2399 patients experienced headache. The weighted mean incidence in sessions was between 9.4% (246 of 2604 sessions) and 12.1% (236/1958 sessions). The variation in incidences of post-ECT headache found might be due to different methods of measuring headache, different study designs, and different drugs used for anesthesia. The mean-weighted incidence of post-ECT headache in patients was 32.8% and in sessions between 9.4% and 12.1%.
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14
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Risk Factors of Relapse After Successful Electroconvulsive Therapy for Taiwanese Patients With Major Depression. J ECT 2020; 36:106-110. [PMID: 31348115 DOI: 10.1097/yct.0000000000000619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Major depressive disorder is a recurrent illness. Treatment strategies are generally focused on achieving remission and preventing relapse/recurrence. The aim of this study was to explore the risk factors associated with relapse for remitted patients during the 12-week follow-up. METHODS This was an open-label trial for major depressive disorder patients receiving acute treatments with electroconvulsive therapy (ECT) and continuation medication in the 12-week follow-up. Symptom severity and psychosocial functioning were assessed using the 17-item Hamilton Rating Scale for Depression (HAMD-17) and the Work and Social Adjustment Scale at each visit. Remission was defined as a HAMD-17 of 7 or less after acute treatment. Relapse was defined as a HAMD-17 of 14 or greater. Subjects achieving remission after acute treatments were included for analysis. Survival analysis was used to investigate the factors associated with relapse. RESULTS Sixty patients receiving ECT for acute treatment were enrolled for 12-week follow-up. Using Cox regression analysis, a greater number of previous major depressive episodes and greater baseline Work and Social Adjustment Scale scores were significantly associated with shorter time to relapse. CONCLUSIONS The goal of acute treatment should focus on functional remission to prevent relapse. Further studies related to more effective treatments to prevent relapse after acute ECT are required in the future.
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15
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Factors affecting time to resolution of suicidality for depressed patients receiving electroconvulsive therapy. CNS Spectr 2020; 25:434-435. [PMID: 31084653 DOI: 10.1017/s1092852919000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Park C, Zuckerman H, Subramaniapillai M, Mansur RB, Rosenblat JD, Cao B, Iacobucci M, Lee Y, Levitan R, Blumberger DM, McIntyre RS. Using early changes in cold cognition to predict response to vortioxetine in major depressive disorder. Psychiatry Res 2020; 284:112767. [PMID: 31978627 DOI: 10.1016/j.psychres.2020.112767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/24/2019] [Accepted: 01/04/2020] [Indexed: 11/28/2022]
Abstract
Antidepressant pharmacotherapy dominates current treatment in psychiatry, including treatment for major depressive disorder (MDD). However, the current trial-and-error process of medication selection contributes to treatment failure and unnecessarily exposes patients to lengthy and insufficient treatment trials. Notably, improvements in measures of cognition have been demonstrated to occur early during treatment and prior to improvements in clinical state. Cognitions have been categorized based on emotional valence (i.e., cold versus hot cognitions). Cold cognitions describe cognitive operations that are relevant to the processing of non-emotional information. The current analysis investigates whether early changes in cold cognition can predict response after 8 weeks of vortioxetine treatment in adults with MDD. This was secondary analysis of an 8-week, open-label study. Cognition was assessed at week 0 and week 2 to measure early cognitive change. Depressive symptom severity was assessed at week 0 and week 8 to measure treatment response. Eighty-one subjects were analyzed using binomial logistic regression models. Early change in cognition was a non-significant predictor of response (p = 0.845, SE = 0.599, OR = 1.124), which may have resulted from high data variability. The overall predictive accuracy of the model was low (sensitivity = 37.5%, specificity = 89.8%, PPV = 70.6%, NPV = 68.8%). Future studies should include larger samples and stratify patients based on potentially moderating variables, such as baseline cognitive impairment and occupation. Stratification would likely produce more homogenous samples, reducing the amount of variability observed for early cognitive change.
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Affiliation(s)
- Caroline Park
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Hannah Zuckerman
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | | | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Bing Cao
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; School of Public Health, Peking University, Beijing 100191, P. R. China
| | - Michelle Iacobucci
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Robert Levitan
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
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17
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Zheng W, Jiang ML, He HB, Li RP, Li QL, Zhang CP, Zhou SM, Yan S, Ning YP, Huang X. Serum BDNF Levels are Not Associated with the Antidepressant Effects of Nonconvulsive Electrotherapy. Neuropsychiatr Dis Treat 2020; 16:1555-1560. [PMID: 32606707 PMCID: PMC7319526 DOI: 10.2147/ndt.s256278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/06/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Brain-derived neurotrophic factor (BDNF) has been implicated in the pathophysiology of depression and in the antidepressant response. This study examined whether changes in serum BDNF levels are associated with the antidepressant effects of nonconvulsive electrotherapy (NET). METHODS For BDNF analyses, serum samples were collected from 20 patients with treatment-refractory depression (TRD) and from 20 healthy controls. Serum samples were also collected from patients following a course of NET. RESULTS Although significantly lower baseline serum BDNF levels were observed in TRD patients than in healthy controls, no changes in serum BDNF levels were found in TRD patients after a course of NET compared to baseline. No significant association was found between serum BDNF levels and depression severity. CONCLUSION Serum BDNF levels appear to have no clinical utility in the prediction of the antidepressant effects of NET in patients with TRD. Future studies of higher quality and with larger sample sizes are needed to confirm these findings.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Miao-Ling Jiang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Hong-Bo He
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Ri-Peng Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Qi-Long Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Chun-Ping Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Su-Miao Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Su Yan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Xiong Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
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18
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Hicks PB, Sevilimedu V, Johnson GR, Tal I, Chen P, Davis LL, Vertrees JE, Mohamed S, Zisook S. Predictability of Nonremitting Depression After First 2 Weeks of Antidepressant Treatment: A VAST‐D Trial Report. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2019; 1:58-67. [PMID: 36101874 PMCID: PMC9176018 DOI: 10.1176/appi.prcp.20190003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/12/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: In this secondary analysis of data from the Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST‐D) study, the authors sought to determine the effectiveness of early improvement (or lack thereof) for predicting remission from depression with antidepressant therapy. Methods: This study used data from the VAST‐D study, a multisite, randomized, single‐blind trial with parallel assignment to one of three medication interventions for 1,522 veterans whose major depressive disorder was unresponsive to at least one course of antidepressant treatment meeting minimal standards for dosage and duration. The authors calculated the positive predictive value (PPV) and negative predictive value (NPV) of early improvement on remission, response, or greater than minimal improvement from depression for various degrees of improvement (10%–50%) on the Quick Inventory of Depressive Symptomatology–Clinician Rated (QIDS‐C) at 1, 2, 4, and 6 weeks. Results: The end of week 2 of treatment was identified as the best time to evaluate early improvement. The presence of a ≥20% drop from the baseline QIDS‐C score by the end of week 2 resulted in a PPV for remission of 38% and an NPV of 93% by week 12. Extending the observational window to week 6 minimally improved NPV (97%). This association did not differ across treatment groups. Conclusions: A lack of early improvement at the end of week 2 of antidepressant therapy can be used to inform clinical decisions on the likelihood of nonremission of depression during the subsequent 10 weeks, even when dosage optimization is incomplete.
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Affiliation(s)
- Paul B. Hicks
- Department of PsychiatryBaylor Scott & White Health
- Texas A&M College of MedicineTempleTexas
| | - Varadan Sevilimedu
- Yale University School of Public HealthNew HavenConnecticut
- Cooperative Studies Program Coordinating CenterVeterans Affairs (VA) Connecticut Healthcare SystemWest Haven
| | - Gary R. Johnson
- Cooperative Studies Program Coordinating CenterVeterans Affairs (VA) Connecticut Healthcare SystemWest Haven
| | | | - Peijun Chen
- Louis Stokes Cleveland VA Medical CenterClevelend
| | - Lori L. Davis
- Tuscaloosa VA Medical CenterTuscaloosaAlabama
- University of Alabama School of MedicineBirmingham
| | - Julia E. Vertrees
- Cooperative Studies Program Clinical Research Pharmacy Coordinating CenterAlbuquerqueNew Mexico
| | - Somaia Mohamed
- VA New England Mental Illness Research, Education, and Clinical CenterVA Connecticut Healthcare SystemWest Haven
| | - Sidney Zisook
- VA San Diego Healthcare SystemSan Diego
- Department of PsychiatryUniversity of CaliforniaSan Diego
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19
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Huang CJ, Lin CH, Wu JI, Yang WC. The Relationship Between Depression Symptoms and Anxiety Symptoms During Acute ECT for Patients With Major Depressive Disorder. Int J Neuropsychopharmacol 2019; 22:609-615. [PMID: 31282929 PMCID: PMC6822139 DOI: 10.1093/ijnp/pyz038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/07/2019] [Accepted: 07/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We investigated the efficacy of electroconvulsive therapy in patients with major depressive disorder and concomitant anxiety symptoms and explored the relationships between depression symptoms and anxiety symptoms during acute electroconvulsive therapy. METHODS Major depressive disorder inpatients (N = 130) requiring electroconvulsive therapy were recruited for a maximum of 12 treatments each. Depression symptoms, using the core factor subscale derived from the 17-item Hamilton Depression Rating Scale, and anxiety symptoms, using the anxiety/somatization subscale from the Hamilton Depression Rating Scale-17, were assessed before electroconvulsive therapy, after every 3 electroconvulsive therapy treatments, and after the final electroconvulsive therapy. Both core factor subscale and anxiety/somatization subscale scores were converted to T-score units to compare the degrees of changes between depression symptoms and anxiety symptoms after electroconvulsive therapy. The relationships between core factor subscale and anxiety/somatization subscale were analyzed using the cross-lagged longitudinal model during acute electroconvulsive therapy. RESULTS A total 116 patients who completed at least the first 3 electroconvulsive therapy treatments were included in the analysis. Reduction of core factor scale T-scores was significantly greater than that of anxiety/somatization subscale T-scores. The model satisfied all indices of goodness-of-fit (chi-square = 30.204, df = 24, P = 0.178, Tucker-Lewis Index = 0.976, Comparative Fit Index = 0.989, Root Mean Square Error of Approximation = 0.047). Core factor subscale changes did not definitely predict subsequent anxiety/somatization subscale changes. CONCLUSIONS Electroconvulsive therapy is effective in the acute treatment of major depressive disorder patients associated with anxiety symptoms. Anxiety symptoms improved less than depression symptoms during acute electroconvulsive therapy. However, earlier reduction in depression symptoms does not definitely drive subsequent relief in anxiety symptoms.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan,Correspondence: Ching-Hua Lin, MD, PhD, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Rd., Ling-Ya District, Kaohsiung 802, Taiwan ()
| | - Jyh-I Wu
- Department of Anesthesiology, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Wei-Cheng Yang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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20
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Lin CH, Park C, McIntyre RS. Early improvement in HAMD-17 and HAMD-7 scores predict response and remission in depressed patients treated with fluoxetine or electroconvulsive therapy. J Affect Disord 2019; 253:154-161. [PMID: 31035216 DOI: 10.1016/j.jad.2019.04.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/13/2019] [Accepted: 04/21/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Compared to the 17-Item Hamilton Rating Scale for Depression (HAMD-17), the 7-Item Hamilton Rating Scale for Depression (HAMD-7) would be more practical for use in busy clinical settings. Herein, we aim to evaluate (1) whether the HAMD-7 is a reliable and valid measure that is sensitive to changes in depressive symptoms, and (2) whether early improvement of depressive symptoms, as measured by the HAMD-7, is capable of predicting response and remission in patients with major depressive disorder (MDD) during acute treatment with fluoxetine or electroconvulsive therapy (ECT). METHODS This is a post-hoc analysis of two clinical trials in MDD. Internal consistency, validity, and sensitivity-to-change of the HAMD-17 and HAMD-7 were compared during acute treatment and at 3-month follow-up. Receiver operating characteristic analyses were used to evaluate the discriminative capacity of the HAMD-17 and HAMD-7. RESULTS The HAMD-7 is a reliable and valid measure that is sensitive to changes in depressive symptoms. Early improvement, as measured by either the HAMD-17 or HAMD-7, was capable of predicting response and remission to acute treatment with fluoxetine or ECT with good discriminative capacity. LIMITATIONS This is a post-hoc analysis of two open-label clinical trials with limited sample sizes. All patients were Taiwanese, which limits the generalizability of our results. CONCLUSIONS HAMD-7 is a clinically useful measure that is capable of detecting early improvement of depressive symptoms. The HAMD-7 may have the potential to inform clinical assessment as part of measurement-based care.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Caroline Park
- Institute of Medical Science, University of Toronto, Toronto, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation (BCDF), Toronto, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
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21
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Lin HS, Lin CH. Early improvement in HAMD-17 and HAMD-6 scores predicts ultimate response and remission for depressed patients treated with fluoxetine or ECT. J Affect Disord 2019; 245:91-97. [PMID: 30368075 DOI: 10.1016/j.jad.2018.10.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/24/2018] [Accepted: 10/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND HAMD-6 is derived from the 17-item Hamilton Rating Scale for Depression (HAMD-17).We explore whether HAMD-6 is a reliable, valid, and sensitive to change measure, and whether early improvement using HAMD-6 can predict ultimate response/remission for inpatients with major depressive disorder (MDD) receiving either fluoxetine or electroconvulsive therapy (ECT). METHODS Data were from 2 trials for 126 MDD inpatients receiving fluoxetine, and 116 inpatients receiving ECT. Internal consistency, validity, and sensitivity to change using HAMD-17 and HAMD-6 at each assessment were examined and compared. Early improvement was defined as an at least 20% reduction of HAMD-17 or HAMD-6 scores at week 2 for patients receiving fluoxetine, or after 6 treatments for patients receiving ECT. Response was defined as ≥ 50% HAMD-17 score improvement from baseline, and remission was defined as a total HAMD-17 score of ≤ 7 at endpoint. Receiver operating characteristic analysis was used to determine which rating scale had better discriminative capacity. RESULTS HAMD-6 is a reliable, valid, and sensitive to change measure. Early improvement using HAMD-6 had comparable predictive values with that of HAMD-17 for response/remission for patients receiving either fluoxetine or ECT. LIMITATIONS Samples were taken from 2 open-label trials with limited sample sizes. CONCLUSIONS HAMD-6 is a clinically useful measure. Those patients without early improvement, however, have a minimal chance of reaching ultimate response/remission, regardless of whether HAMD-17 or HAMD-6 was use.
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Affiliation(s)
- Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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22
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Martínez-Amorós E, Goldberg X, Gálvez V, de Arriba-Arnau A, Soria V, Menchón JM, Palao DJ, Urretavizcaya M, Cardoner N. Early improvement as a predictor of final remission in major depressive disorder: New insights in electroconvulsive therapy. J Affect Disord 2018; 235:169-175. [PMID: 29656263 DOI: 10.1016/j.jad.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/07/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early improvement to antidepressant drugs predicts remission, but the predictive value of early improvement to electroconvulsive therapy (ECT) is still unclear. The main aim of this study was to determine the optimal definition of early improvement in the treatment of major depressive disorder (MDD) with ECT, by analyzing its value as a predictor of remission. METHODS A naturalistic study was conducted in 87 adult MDD patients treated with acute ECT. ROC curves were generated to identify the best time point (week 1 or 2 of treatment) predicted remission. Sensibility, specificity, and predictive values were calculated for several definitions of early improvement previously proposed in the literature (20%, 25%, 30%, and 35%). Complementary, time to remission was analyzed and a logistic regression model was performed to further characterize the impact of the optimal definition of early improvement on remission while adjusting for other clinically relevant variables. RESULTS A 30% reduction in the HAM-D score after 2 weeks was identified as the optimal definition of early improvement, with acceptable sensitivity (76%), and specificity (67%). Complementary analyses provided further support for this definition showing a shorter time to remission and a significant effect adjusted for the rest of variables. LIMITATIONS Relatively small sample size, ECT restricted to brief bilateral treatment. CONCLUSIONS Early improvement, defined as a 30% of reduction in the HAM-D21 score at week 2, is a good predictor of remission in MDD patients treated with bilateral ECT, with potential clinical impact. Lack of early improvement could indicate a need for further changes in treatment strategies.
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Affiliation(s)
- Erika Martínez-Amorós
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Ximena Goldberg
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Verònica Gálvez
- School of Psychiatry, University of NSW. Black Dog Institute, Sydney, Randwick, Australia
| | - Aida de Arriba-Arnau
- Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Virginia Soria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - José M Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Diego J Palao
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Mikel Urretavizcaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain.
| | - Narcís Cardoner
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain.
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Mechri A, Zaafrane H, Khalifa MH, Toumi S, Zaafrane F, Gaha L. Pratique de l'électroconvulsivothérapie dans un hôpital universitaire Tunisien. Pan Afr Med J 2018; 29:6. [PMID: 29632628 PMCID: PMC5889509 DOI: 10.11604/pamj.2018.29.6.11887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 11/23/2017] [Indexed: 11/11/2022] Open
Abstract
This study aimed to describe the practice of electroconvulsivotherapy (ECT) at the University Hospital of Monastir (Tunisia). We conducted a retrospective study of all patients treated by ECT at the University Hospital of Monastir between 2002 and 2013. 80 patients were enrolled in the study (60 men and 20 women, with an average age of 42.1±15.7 years), accounting for 1.4% of all patients hospitalized in Psychiatry Department during the study period. The total number of ECT sessions was 784. In 50% of patients, the primary diagnosis was a major isolated or recurring depressive disorder. The majority of patients (78.8%) had undergone only one ECT session, with an average number of sessions of 8.1 ± 4.9. The most used anesthetic product was the propofol (97.4%). In 71% of cases the energy delivered was between 40 and 80 joules and it was positively correlated with patients' age. The average duration of the motor seizure was 22.3 ± 7.2 seconds and it was negatively correlated with patients' age. The highest response rate was found in depression scores (64.3%). Immediate adverse effects occurred in 51.2% of patients. Finally, 20% of patients continued to undergo maintenance ECT sessions on a weekly or a biweekly basis. The practice of ECT at the University Hospital of Monastir has been little developed in terms of number of patients and ECT sessions. Efforts should be made to promote the use of this method.
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Affiliation(s)
- Anwar Mechri
- Service de Psychiatrie, CHU Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - Hana Zaafrane
- Service de d'Anesthésie Réanimation, CHU Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - Monia Hadj Khalifa
- Service de Psychiatrie, CHU Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - Samir Toumi
- Service de d'Anesthésie Réanimation, CHU Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - Férid Zaafrane
- Service de Psychiatrie, CHU Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - Lotfi Gaha
- Service de Psychiatrie, CHU Fattouma Bourguiba de Monastir, Monastir, Tunisie
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van Diermen L, van den Ameele S, Kamperman AM, Sabbe BCG, Vermeulen T, Schrijvers D, Birkenhäger TK. Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis. Br J Psychiatry 2018; 212:71-80. [PMID: 29436330 DOI: 10.1192/bjp.2017.28] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates. Aims To investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression. METHOD A meta-analysis was conducted according to the PRISMA statement. A literature search identified recent studies that reported on at least one of the potential predictors. RESULTS Of the 2193 articles screened, 34 have been included for meta-analysis. Presence of psychotic features is a predictor of ECT remission (odds ratio (OR) = 1.47, P = 0.001) and response (OR = 1.69, P < 0.001), as is older age (standardised mean difference (SMD) = 0.26 for remission and 0.35 for response (P < 0.001)). The severity of depression predicts response (SMD = 0.19, P = 0.001), but not remission. Data on melancholic symptoms were inconclusive. CONCLUSIONS ECT is particularly effective in patients with depression with psychotic features and in elderly people with depression. More research on both biological and clinical predictors is needed to further evaluate the position of ECT in treatment protocols for major depression. Declaration of interest None.
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Affiliation(s)
- Linda van Diermen
- Collaborative Antwerp Psychiatric Research Institue (CAPRI),Department of Biomedical Sciences,University of Antwerp,Belgium
| | - Seline van den Ameele
- CAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium and University Department,Psychiatric Hospital Duffel,VZW Emmaüs,Duffel,Belgium
| | - Astrid M Kamperman
- Epidemiological and Social Psychiatric Research Institute (ESPRi),Department of Psychiatry,Erasmus University Medical Centre,Rotterdam,the Netherlands
| | - Bernard C G Sabbe
- CAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium and University Department,Psychiatric Hospital Duffel,VZW Emmaüs,Duffel,Belgium
| | - Tom Vermeulen
- CAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium and University Department,Psychiatric Hospital Duffel,VZW Emmaüs,Duffel,Belgium
| | - Didier Schrijvers
- CAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium and University Department,Psychiatric Hospital Duffel,VZW Emmaüs,Duffel,Belgium
| | - Tom K Birkenhäger
- Department of Psychiatry,Erasmus University Medical Center,Rotterdam,the NetherlandsandCAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium
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25
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Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression. Brain Stimul 2018; 11:181-189. [DOI: 10.1016/j.brs.2017.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/27/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022] Open
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Lin CH, Huang CJ, Chen CC. ECT Has Greater Efficacy Than Fluoxetine in Alleviating the Burden of Illness for Patients with Major Depressive Disorder: A Taiwanese Pooled Analysis. Int J Neuropsychopharmacol 2017; 21:63-72. [PMID: 29228200 PMCID: PMC5795346 DOI: 10.1093/ijnp/pyx114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The burden of major depressive disorder includes suffering due to symptom severity, functional impairment, and quality of life deficits. The aim of this study was to compare the differences between electroconvulsive therapy and pharmacotherapy in reducing such burdens. METHODS This was a pooled analysis study including 2 open-label trials for major depressive disorder inpatients receiving either standard bitemporal and modified electroconvulsive therapy with a maximum of 12 sessions or 20 mg/d of fluoxetine for 6 weeks. Symptom severity, functioning, and quality of life were assessed using the 17-item Hamilton Rating Scale for Depression, the Modified Work and Social Adjustment Scale, and SF-36. Side effects following treatment, including subjective memory impairment, nausea/vomiting, and headache, were recorded. The differences between these 2 groups in 17-item Hamilton Rating Scale for Depression, Modified Work and Social Adjustment Scale, quality of life, side effects, and time to response (at least a 50% reduction of 17-item Hamilton Rating Scale for Depression) and remission (17-item Hamilton Rating Scale for Depression ≤7) following treatment were analyzed. RESULTS Electroconvulsive therapy (n=116) showed a significantly greater reduction in 17-item Hamilton Rating Scale for Depression, Modified Work and Social Adjustment Scale, and quality of life deficits and had significantly shorter time to response/remission than fluoxetine (n=126). However, the electroconvulsive therapy group was more likely to experience subjective memory impairment and headache. CONCLUSIONS Compared with fluoxetine, electroconvulsive therapy was more effective in alleviating the burden of major depressive disorder and had a substantially increased speed of response/remission in the acute phase. Increased education and information about electroconvulsive therapy for clinicians, patients, and their families and the general public is warranted.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan,Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Correspondence: Ching-Hua Lin, MD, PhD, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Rd., Ling-Ya District, Kaohsiung 802, Taiwan ()
| | - Chun-Jen Huang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Chung Chen
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan,Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Early Improvement Predicts Treatment Outcomes for Patients With Acute Mania: A Naturalistic Study in Taiwan. J Clin Psychopharmacol 2017; 37:435-440. [PMID: 28590370 DOI: 10.1097/jcp.0000000000000728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bipolar disorder is a serious mental disorder. This study investigated whether early improvement at week 1 or 2 could predict treatment outcomes at week 4 in clinical populations with acute mania. METHODS We conducted a naturalistic study, recruiting inpatients with bipolar mania for acute treatment. Symptom severity was assessed using the Young Mania Rating Scale (YMRS) at weeks 0, 1, 2, 3, and 4. Early improvement was defined as a reduction in the YMRS score of at least 20% or 25%, assessed at weeks 1 and 2. Response was defined as a reduction of 50% or more in the YMRS score, and remission was defined as an end-point YMRS score of 12 or less. Receiver operating characteristic curves were used to determine whether week 1 or week 2 had better discriminative capacity. Sensitivity, specificity, and predictive values were calculated for the different definitions of early improvement. RESULTS Of the 350 patients, 32.9% (n = 115) and 16.6% (n = 58) of the subjects were classified as responders and remitters at week 4, respectively. Early improvement at week 2 showed better discriminative capacity, with areas under the receiver operating characteristic curve greater than 0.8. It had high sensitivity and high negative predictive value for 2 cutoffs in predicting response and remission. CONCLUSIONS Relatively lower response and remission rates were observed. Response and remission could be predicted by early improvement at week 2, whereas patients without early improvement were unlikely to reach response and remission at week 4.
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Lin CH, Yang WC. The Relationship between Symptom Relief and Psychosocial Functional Improvement during Acute Electroconvulsive Therapy for Patients with Major Depressive Disorder. Int J Neuropsychopharmacol 2017; 20:538-545. [PMID: 28430980 PMCID: PMC5492785 DOI: 10.1093/ijnp/pyx022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/17/2017] [Indexed: 11/13/2022] Open
Abstract
Background We aimed to compare the degree of symptom relief to psychosocial functional (abbreviated as "functional") improvement and explore the relationships between symptom relief and functional improvement during acute electroconvulsive therapy for patients with major depressive disorder. Methods Major depressive disorder inpatients (n=130) requiring electroconvulsive therapy were recruited. Electroconvulsive therapy was generally performed for a maximum of 12 treatments. Symptom severity, using the 17-item Hamilton Depression Rating Scale, and psychosocial functioning (abbreviated as "functioning"), using the Modified Work and Social Adjustment Scale, were assessed before electroconvulsive therapy, after every 3 electroconvulsive therapy treatments, and after the final electroconvulsive therapy. Both 17-item Hamilton Depression Rating Scale and Modified Work and Social Adjustment Scale scores were converted to T-score units to compare the degrees of changes between depressive symptoms and functioning after electroconvulsive therapy. Structural equation modeling was used to test the relationships between 17-item Hamilton Depression Rating Scale and Modified Work and Social Adjustment Scale during acute electroconvulsive therapy. Results One hundred sixteen patients who completed at least the first 3 electroconvulsive therapy treatments entered the analysis. Reduction of 17-item Hamilton Depression Rating Scale T-scores was significantly greater than that of Modified Work and Social Adjustment Scale T-scores at assessments 2, 3, 4, and 5. The model analyzed by structural equation modeling satisfied all indices of goodness-of-fit (chi-square = 32.882, P =.107, TLI = 0.92, CFI = 0.984, RMSEA = 0.057). The 17-item Hamilton Depression Rating Scale change did not predict subsequent Modified Work and Social Adjustment Scale change. Conclusions Functioning improved less than depressive symptoms during acute electroconvulsive therapy. Symptom reduction did not predict subsequent functional improvement. Depressive symptoms and functional impairment are distinct domains and should be assessed independently to accurately reflect the effectiveness of electroconvulsive therapy.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Cheng Yang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Factors Related to the Changes in Quality of Life for Patients With Depression After an Acute Course of Electroconvulsive Therapy. J ECT 2017; 33:126-133. [PMID: 27668944 DOI: 10.1097/yct.0000000000000358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effect of electroconvulsive therapy (ECT) on quality of life (QOL), depressive symptoms, and functioning for patients with depression, and to explore the variables related to QOL changes. METHODS Ninety-five inpatients with depression receiving at least 6 ECT sessions and completed all measures were included. Quality of life, symptom severity, and functioning were assessed using Short Form 36 (SF-36), the 17-item Hamilton Rating Scale for Depression (HAMD-17), and the Modified Work and Social Adjustment Scale (MWSAS), before and after ECT. The SF-36 includes 8 subscales, physical component summary (PCS), and mental component summary (MCS). Adverse effects after ECT, including headache, muscle pain, and nausea/vomiting, were also recorded. RESULTS All 8 SF-36 subscales, PCS, MCS, HAMD-17, and MWSAS improved significantly after treatment. Using multiple linear regression analysis, MWSAS changes predicted PCS changes significantly after adjusting for baseline PCS. Similarly, using multiple linear regression analysis, MWSAS changes were significant variables associated with MCS changes after adjusting for ECT frequency, HAMD-17 changes, and baseline MCS. The ECT improved QOL, depressive symptoms, and functioning. CONCLUSIONS Whether strategies to enhance functioning during an acute course of ECT could improve QOL is needed to be examined in a further study.
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Clinical factors related to acute electroconvulsive therapy outcome for patients with major depressive disorder. Int Clin Psychopharmacol 2017; 32:127-134. [PMID: 28177952 DOI: 10.1097/yic.0000000000000167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to explore the significant predictors associated with electroconvulsive therapy (ECT) outcome for patients with major depressive disorder. Major depressive disorder inpatients (N=130) requiring ECT were recruited from a major psychiatric center in South Taiwan. ECT was generally performed for a maximum of 12 sessions. Symptom severity was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17) and Clinical Global Impression of Severity (CGI-S) before ECT, after every three ECT sessions, and after the last ECT. The generalized estimating equations method was used to analyze the influence of potential variables over time on the HAMD-17 and CGI-S, respectively. Fourteen patients not completing the first three sessions of ECT were excluded. The remaining 116 patients were included in the analysis. Patients with treatment-resistant depression, longer duration of the current depressive episode, and higher levels of pain were more likely to have less symptom reduction after acute treatment with ECT, irrespective of how the depressive symptoms were rated using HAMD-17 or CGI-S. To improve efficacy, earlier application of ECT and pain control should be considered during an acute course of ECT. Other clinical predictors related to ECT outcome require further investigation in future studies.
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