Classics in ECT: Abrams, Fink and Feldstein on Prediction of ECT response
"Classics in ECT" brings you this study from the British Journal of Psychiatry in 1973:
Prediction of clinical response to ECT.
Br J Psychiatry. 1973 Apr;122(569):457-60. doi: 10.1192/bjp.122.4.457.PMID: 4718282
This study from the early 1970s was an attempt to replicate three previously published methods for "calculating an index for prediction of response to ECT" in depressed patients. The results were completely negative. None of those methods has survived, and nothing has really replaced them.
The evolution of research in ECT response prediction is fascinating. The fact that we have not achieved perfect accuracy is both frustrating and expected in such a complex clinical situation. Of course, since ECT works so well, it makes the need for precision less urgent; most "seriously ill" depressed patients will get well with ECT, as will almost all patients with catatonia.
The clinical profile of likely ECT responders is well known to clinicians; psychotic depression responds almost like ECT is penicillin and the depression is strep. The more "severe" and "biological" the illness, the greater the certainty of response and remission. Clinicians "know it when they see it." Not exactly Level I evidence, but operationally effective. Some colleagues and I have suggested that "appropriateness" for ECT is determined by depression severity, episodicity and family history; but "appropriateness" is not exactly the same thing as prediction.
An important subset of the response prediction realm involves electrode placement: who does NOT respond to RUL? It would be very clinically useful to predict this with accuracy...
Some of the best recent work in ECT response prediction is from Linda van Diermen:
Toward Targeted ECT: The Interdependence of Predictors of Treatment Response in Depression Further Explained.
J Clin Psychiatry. 2020 Dec 15;82(1):20m13287. doi: 10.4088/JCP.20m13287PMID: 33326710
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