Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT

Abstract

Background: Health-related quality of life (HRQOL) is diminished in depressed adult outpatients and especially impaired among depressed patients referred for ECT. We compare pretreatment HRQOL in ECT and non-ECT depressed patients from two large samples, and examined whether sustained remission in depressive symptoms after ECT is associated with normalization of HRQOL.

Methods: HRQOL was measured with the Medical Outcomes Study Short Form 36 (SF36) before ECT and 6 months after ECT in an effectiveness (n=286) and an efficacy (n=243) clinical trial.

Results: ECT patients had very low baseline SF36 scores. With one exception, SF36 subscale scores in both trials were significantly lower than those of depressed outpatients. A minority of patients in both trials entered and sustained remission over the 24 week timeframe. Among sustained remitters, average SF36 scores were no different from normative scores of the general adult population, except that in the effectiveness study ECT patients reported less Bodily Pain (p<0.05) and better Mental Health (p<0.05), while in the efficacy study ECT patients reported more difficulty with Role-Emotional (p<0.01).

Limitations: Only a modest number of patients were observed in sustained remission.

Conclusions: HRQOL is very poor in patients referred for ECT. Depressed patients who experience sustained remission after ECT, however, can expect improvement in their quality of life that leaves many in a position indistinguishable from the general adult population.

Trial registration: ClinicalTrials.gov NCT00045916.

Conflict of interest statement

Conflict of Interest: Dr McCall’s present work in ECT is supported by NIMH 1U01MH086127-01

Dr Prudic’s present work is supported by NIMH 1U01MH084241, NARSAD, and Alzheimer’s AssociationIIRG-09-131861

Dr. McCall has been a scientific advisor for Sunovion and Astra Zeneca within the last 24 months

Dr Reboussin has no disclosures

Dr Prudic has no disclosures

Dr Haskett has no disclosures

Dr Isenberg is a full-time employee of WellPoint. Points of view expressed in the paper do not necessarily reflect the official position of WellPoint.

Dr Olfson has no disclosures

Dr Rosenquist has no disclosures

Dr Sackeim is a consultant for the following: Cervel Neurotech, Inc.; Cyberonics Inc.; Eli Lilly; Magstim Limited; MECTA Corporation; Neuronetics Inc.; NeuroPace Inc.; Novartis Inc., Pfizer Inc.

Copyright © 2013 Elsevier B.V. All rights reserved.

Figures

Figure 1

Baseline SF-36 scores for Services-ECT patients (N=286, mean age 55.6 years) versus Outpatients with Depression (N=502) and Normals aged 55–64 (N=269)

Figure 2

SF36 bar graph scores after 24 weeks of remission in Services ECT project (N=38, mean age 59.8), and Normals aged 55–64 (N=269)

Figure 3

Baseline SF-36 bar graphs scores for OPT-ECT patients (N=243, mean age 47.7) versus Outpatients with Depression (N=502) and Normals aged 45–54 (N=338)

Figure 4

SF36 bar graph scores after 24 weeks of remission in OPT ECT (N=26, mean age 52.6) and Normals aged 45 54 (N=338)