Improvement after two sessions of electroconvulsive therapy predicts final remission in in-patients with major depression

T K Birkenhager, J Roos, A M Kamperman, T K Birkenhager, J Roos, A M Kamperman

Abstract

Objective: To investigate whether early improvement, measured after two electroconvulsive therapy (ECT) sessions, is a good predictor of eventual remission in severely depressed in-patients receiving ECT.

Method: A prospective cohort study was performed that included 89 major depressive disorder in-patients treated with bilateral ECT. Sensitivity, specificity, and predictive values were computed for various definitions of early improvement (15%, 20%, 25%, and 30% reduction on the Montgomery Asberg depression rating scale (MADRS) score) after 1 week (i.e. two sessions) of ECT regarding prediction of remission (final MADRS score ≤ 9).

Results: A 15% reduction in MADRS score appeared to be the best definition of early improvement, with modest sensitivity (51%) and relatively good specificity (79%). Kaplan-Meier analysis showed a more than 2-week shorter time to remission in patients with early improvement compared with patients lacking early improvement.

Conclusion: Early improvement during an ECT course may be assessed after two ECT sessions. Such improvement, defined as a 15% reduction in the MADRS score, is a moderately sensitive predictor for eventual remission in an in-patient population with severe major depression.

Keywords: early improvement; electroconvulsive therapy; major depression; remission.

© 2019 The Authors. Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Flowchart of inclusion of study sample.
Figure 2
Figure 2
Kaplan–Meier curve: time to remission in both subgroups. Mean time to remission in early improvers: 6.49 weeks, 95% CI 5.61–7.36; In patients without early improvement: 8.82 weeks, 95% CI 7.94–9.69. Breslow test: Χ2 = 12.67, P = 0.01.

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