Depression Severity and ECT Prescription in Japan: New Study in Asian Journal of Psychiatry

 Out on PubMed, from investigators in Japan, is this study:

Characteristics of the treatments for each severity of major depressive disorder: A real-world multi-site study.

Muraoka H, Kodaka F, Hasegawa N, Yasui-Furukori N, Fukumoto K, Kashiwagi H, Tagata H, Hori H, Atake K, Iida H, Ichihashi K, Furihata R, Tsuboi T, Takeshima M, Komatsu H, Kubota C, Ochi S, Takaesu Y, Usami M, Nagasawa T, Makinodan M, Nakamura T, Kido M, Ueda I, Yamagata H, Onitsuka T, Asami T, Hishimoto A, Ogasawara K, Katsumoto E, Miura K, Matsumoto J, Ohi K, Yamada H, Watanabe K, Inada K, Nishimura K, Hashimoto R.Asian J Psychiatr. 2022 May 18;74:103174. doi: 10.1016/j.ajp.2022.103174. Online ahead of print. PMID: 35661492

The abstract is copied below:Purpose: In the treatment guidelines for major depressive disorder (MDD), the recommended treatment differs based on the severity. However, the type of treatment provided based on the severity of MDD in real-world clinical practice has not been investigated. In this study, we clarified the actual situation of MDD treatment in clinical practice and compared the treatment based on the severity of MDD.
Methods: We used data from 1484 patients with MDD at discharge from October 2016 to March 2020.
Results: The number of psychotropic prescriptions tended to be lower in those diagnosed with MDD in the severe group compared to in the non-severe group. There were significant differences among the three groups (mild, moderate/severe, and psychotic) in the percentage of patients who were not prescribed antipsychotics (p = 1.9 ×10-6), a combination of antipsychotics and antidepressants (p = 5.0 ×10-4), and the implementation rate of modified electroconvulsive therapy (m-ECT) (p = 3.4 ×10-9). The percentage of patients with a severe diagnosis who underwent m-ECT was higher, which corresponded to the severity.
Conclusion: Our findings showed that the use of psychotropics decreased when the severity of MDD was diagnosed, and the rate of a combination of antipsychotics and antidepressants and the implementation rate of m-ECT increased with the severity. However, this study suggests that there is still an evidence-practice gap in the treatment of MDD in Japan, and guidelines are only partially adhered to in the treatment of depression.

Keywords: Depression; ECT; EGUIDE; Guideline; Severity.

And from the text:

No big surprises here, but it is interesting to see some data about ECT use in Japan added to the literature. There appears to be reasonable use of ECT in psychotic depression. Severity of illness is a topic that needs to be better explained to the public, so that the appropriate place of ECT in the treatment armamentarium can be understood and accepted.

One nit to pick: these authors insist on calling ECT "mECT", where the "m" means "modified." Time to delete the modifier and call ECT, "ECT".

No need to read the details here (~ 15 minutes), unless you have an interest in the topic of adherence to psychiatric treatment guidelines.