A Prediction Model for ECT Effectiveness From the Dutch ECT Consortium (DEC)

 Out on PubMed, from authors in the Netherlands, is this paper:

A prediction model for electroconvulsive therapy effectiveness in patients with major depressive disorder from the Dutch ECT Consortium (DEC).

Loef D, Hoogendoorn AW, Somers M, Mocking RJT, Scheepens DS, Scheepstra KWF, Blijleven M, Hegeman JM, van den Berg KS, Schut B, Birkenhager TK, Heijnen W, Rhebergen D, Oudega ML, Schouws SNTM, van Exel E, Rutten BPF, Broekman BFP, Vergouwen ACM, Zoon TJC, Kok RM, Somers K, Verwijk E, Rovers JJE, Schuur G, van Waarde JA, Verdijk JPAJ, Bloemkolk D, Gerritse FL, van Welie H, Haarman BCM, van Belkum SM, Vischjager M, Hagoort K, van Dellen E, Tendolkar I, van Eijndhoven PFP, Dols A.Mol Psychiatry. 2024 Oct 24. doi: 10.1038/s41380-024-02803-2. Online ahead of print.PMID: 39448805

The abstract is copied below:
Reliable predictors for electroconvulsive therapy (ECT) effectiveness would allow a more precise and personalized approach for the treatment of major depressive disorder (MDD). Prediction models were created using a priori selected clinical variables based on previous meta-analyses. Multivariable linear regression analysis was used, applying backwards selection to determine predictor variables while allowing non-linear relations, to develop a prediction model for depression outcome post-ECT (and logistic regression for remission and response as secondary outcome measures). Internal validation and internal-external cross-validation were used to examine overfitting and generalizability of the model's predictive performance. In total, 1892 adult patients with MDD were included from 22 clinical and research cohorts of the twelve sites within the Dutch ECT Consortium. The final primary prediction model showed several factors that significantly predicted a lower depression score post-ECT: higher age, shorter duration of the current depressive episode, severe MDD with psychotic features, lower level of previous antidepressant resistance in the current episode, higher pre-ECT global cognitive functioning, absence of a comorbid personality disorder, and a lower level of failed psychotherapy in the current episode. The optimism-adjusted R² of the final model was 19%. This prediction model based on readily available clinical information can reduce uncertainty of ECT outcomes and hereby inform clinical decision-making, as prompt referral for ECT may be particularly beneficial for individuals with the above-mentioned characteristics. However, despite including a large number of pretreatment factors, a large proportion of the variance in depression outcome post-ECT remained unpredictable.

The article is here.

And from the text:

This is a well-conducted study with a large sample (nearly 2000) in Holland, using clinical predictors to model ECT outcomes. 

The results are as expected, mirroring previous studies and long-held clinical wisdom.

The search for the holy grail of "precision psychiatry" may be the enemy of the good, if it discounts the fact that, for the most part,  experienced clinicians can pretty much tell what illness and patient characteristics make for a good ECT candidate.

I did not see anything about family psychiatric history or episodicity of illness; presumably these data were not readily available.

Despite the lack of surprise, these data are very important; kudos to our Dutch colleagues for this scholarly addition to the ECT response prediction literature.