Finnish TRD Study: Low Use of ECT

Out on PubMed, from Finnish investigators, is this study:

Courses of treatment and risk factors for treatment-resistant depression in Finnish primary and special healthcare: A nationwide cohort study.

Lähteenvuo M, Taipale H, Tanskanen A, Rannanpää S, Tiihonen J.J Affect Disord. 2022 Apr 6:S0165-0327(22)00343-3. doi: 10.1016/j.jad.2022.04.010. Online ahead of print.PMID: 35398108

The abstract is copied below:

Objective: Investigate incidence, risk factors and courses of treatment for treatment-resistant depression (TRD) in primary and special healthcare.

Methods: All patients identified from nationwide registers, aged 16-65 years, diagnosed with depression in Finland during 2004-2016 were included. New antidepressant users were identified with six-month washout period and followed-up for two years to observe for presence of TRD, which was defined as initiation of a third trial after having failed two pharmacological treatment trials with adequate duration.

Results: During follow-up, 177,144 persons had their first registered antidepressant treated depression (mean age: 39.5, 62.5% women). Of them, 10.9% (N = 19,322) met TRD criteria. Among the TRD patients, most common first and second antidepressants trials were: SSRIs (44.6%), mirtazapine (19.0%) and SNRIs (16.5%). As the third treatment line, antidepressant monotherapy (44.2% of TRD patients) was most common, followed by a combination of ≥2 antidepressants (32.1%), antipsychotic or mood stabilizer augmentation and an antidepressant (15.8%), both combination of antidepressants and an augmentation with a mood stabilizer or antipsychotic (4.9%), antipsychotic or mood stabilizer monotherapy (2.7%) and ECT (0.3%). Of TRD patients, 16.5% (N = 3188) progressed to the fifth treatment line, in which the most common treatments were antidepressant monotherapy (33.4%), antidepressant combinations (27.5%) and augmentation (24.2%). Factors associated with higher risk of TRD included male gender, younger age, higher initial disease severity and hospitalization at initial onset of depression.

Conclusions: Antidepressant monotherapies were still the most common fifth line of depression treatment. Severe depression, hospitalization due to depression, young age and male gender may predispose to TRD.

Keywords: Antidepressant; Depression; Epidemiology; MDD; Pharmacoepidemiology; Treatment-resistant depression.

The article is here.

And from the text:

The reason to blog about this paper is simple: the low rate and late prescription of ECT in a large sample of patients with TRD. Of course, Finland is, unfortunately, not an outlier: as documented in many recent data papers and reviews, ECT is under prescribed throughout the world.

This is a good study with a large registry dataset, but the ECT part is small, reflecting the clinical reality.