Clinical Characteristics Associated with Relapse Two Years After ECT for Major Depression: Data From The Lowcountries

Out on Pubmed, from investigators in the Netherlands and Belgium, is this study:

Clinical characteristics associated with relapse two years after electroconvulsive therapy for major depression.

Pluijms EM, Vinther PT, Kamperman AM, Birkenhäger TK.Acta Psychiatr Scand. 2023 Mar 20. doi: 10.1111/acps.13542. Online ahead of print.PMID: 36938869

The abstract is copied below:

Objective: High relapse rates are observed after electroconvulsive therapy (ECT) for major depression. Identifying patients who are at increased risk for relapse to intensify their treatment regimen post-ECT might reduce relapse rates. We aimed to determine clinical characteristics that are associated with relapse within two years after successful ECT.

Methods: Patients who remitted to ECT in a randomised controlled trial comparing adjuvant nortriptyline and placebo during a course of bilateral ECT were followed-up prospectively for one year with open-label nortriptyline (Dutch Trial Register NTR5579). Second-year follow-up data were collected retrospectively. Thirty-four patients were included in this follow-up cohort. To examine the association between clinical characteristics and the risk of relapse, unadjusted hazard ratios (HRs) were calculated.

Results: At two years post-ECT, the overall relapse rate was 50%, and the HRs for relapse in patients with psychotic features, a higher severity of depression, and medication resistance prior to ECT were 0.33 (CI 0.12-0.89; p=0.029), 0.88 (CI 0.80-0.98; p=0.014), and 4.48 (CI 1.28-15.73, p=0.019), respectively. No effect was found for age, sex or episode duration on the relapse rate.

Conclusions: Depressed patients with psychotic features, with higher symptom severity and without medication resistance prior to ECT have a significantly decreased risk of relapse after successful ECT. A sustained remission rate of 50% over two years in patients with severe major depression who were treated with nortriptyline monotherapy after successful ECT is encouraging.

Keywords: Electroconvulsive therapy; major depressive disorder; predictors; relapse.

The article is here.

And from the text:

This is a very nice, well-presented small, (n=34) study of relapse after successful acute bilateral ECT. The findings suggest that the the better the diagnostic "fit" for ECT, the better the patient does in the long term. Note that the maintenance treatment was monotherapy with nortriptyline. I tend to discount the "medication resistance" finding, as it is a feature of the care, and not intrinsic to the patient.

Kudos to our Lowcountry colleagues for this excellent contribution to the ECT literature.