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Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis

  • Linda van Diermen (a1), Seline van den Ameele (a1), Astrid M. Kamperman (a2), Bernard C.G. Sabbe (a3), Tom Vermeulen (a3), Didier Schrijvers (a3) and Tom K. Birkenhäger (a4)...
  • Please note a correction has been issued for this article.

Abstract

Background

Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates.

Aims

To investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression.

Method

A meta-analysis was conducted according to the PRISMA statement. A literature search identified recent studies that reported on at least one of the potential predictors.

Results

Of the 2193 articles screened, 34 have been included for meta-analysis. Presence of psychotic features is a predictor of ECT remission (odds ratio (OR) = 1.47, P = 0.001) and response (OR = 1.69, P < 0.001), as is older age (standardised mean difference (SMD) = 0.26 for remission and 0.35 for response (P < 0.001)). The severity of depression predicts response (SMD = 0.19, P = 0.001), but not remission. Data on melancholic symptoms were inconclusive.

Conclusions

ECT is particularly effective in patients with depression with psychotic features and in elderly people with depression. More research on both biological and clinical predictors is needed to further evaluate the position of ECT in treatment protocols for major depression.

Declaration of interest

None.

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Copyright

Corresponding author

Correspondence: Linda van Diermen, University Department, Psychiatric Hospital Duffel, Stationsstraat 22c, 2570 Duffel, Belgium. Email: linda.vandiermen@uantwerpen.be

References

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1Milev, RV, Giacobbe, P, Kennedy, SH, Blumberger, DM, Daskalakis, ZJ, Downar, J, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. Can J Psychiatry 2016; 6: 561–75.
2Bauer, M, Pfennig, A, Severus, E, Whybrow, PC, Angst, J, Möller, H-J, et al. World federation of societies of biological psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 2013; 14: 334–85.
3American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. American Psychiatric Association, 2010. (https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf)
4The National Institute for Health and Care Excellence. Depression: The Treatment and Management of Depression in Adults (Updated Edition). NICE, 2010.
5Ellis, P, Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Depression. Australian and New Zealand clinical practice guidelines for the treatment of depression. Aust N Z J Psychiatry 2004; 38: 389407.
6Haq, AU, Sitzmann, AF, Goldman, ML, Maixner, DF, Mickey, BJ. Response of depression to electroconvulsive therapy: a meta-analysis of clinical predictors. J Clin Psychiatry 2015; 76: 1374–84.
7Kellner, CH, Greenberg, RM, Murrough, JW, Bryson, EO, Briggs, MC, Pasculli, RM. ECT in treatment-resistant depression. Am J Psychiatry 2012; 169: 1238–44.
8Husain, MM, Rush, AJ, Fink, M, Knapp, R, Petrides, G, Rummans, T, et al. Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report. J Clin Psychiatry 2004; 65: 485–91.
9McIntyre, RS, O'Donovan, C. The human cost of not achieving full remission in depression. Can J Psychiatry 2004; 49 (3 suppl 1): 10S16S.
10Moher, D, Shamseer, L, Clarke, M, Ghersi, D, Liberati, A, Petticrew, M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1.
11Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 2000; 283: 2008–12.
12Bauer, M, Pfennig, A, Linden, M, Smolka, MN, Neu, P, Adli, M. Efficacy of an algorithm-guided treatment compared with treatment as usual: a randomized, controlled study of inpatients with depression. J Clin Psychopharmacol 2009; 29: 327–33.
13Bharadwaj, V, Grover, S, Chakrabarti, S, Avasthi, A, Kate, N. Clinical profile and outcome of bipolar disorder patients receiving electroconvulsive therapy: a study from north India. Indian J Psychiatry 2012; 54: 41–7.
14Birkenhäger, TK, Pluijms, EM, Ju, MR, Mulder, PG, van den Broek, WW. Influence of age on the efficacy of electroconvulsive therapy in major depression: a retrospective study. J Affect Disord 2010; 126: 257–61.
15Birkenhager, TK, Pluijms, EM, Lucius, SAP. ECT response in delusional versus non-delusional depressed inpatients. J Affect Disord 2003; 74: 191–5.
16Bjølseth, TM, Engedal, K, Benth, , Dybedal, GS, Gaarden, TL, Tanum, L. Clinical efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy (ECT) in the treatment of major depression among elderly patients: a pragmatic, randomized, assessor-blinded, controlled trial. J Affect Disord 2015; 175: 817.
17Bumb, JM, Aksay, SS, Janke, C, Kranaster, L, Geisel, O, Gass, P, et al. Focus on ECT seizure quality: serum BDNF as a peripheral biomarker in depressed patients. Eur Arch Psychiatry Clin Neurosci 2015; 265: 227–32.
18Joshi, SH, Espinoza, RT, Pirnia, T, Shi, J, Wang, Y, Ayers, B, et al. Structural plasticity of the hippocampus and amygdala induced by electroconvulsive therapy in major depression. Biol Psychiatry 2015; 17: 111.
19O'Connor, MK, Knapp, R, Husain, M, Rummans, Ta, Petrides, G, Smith, G, et al. The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report. Am J Geriatr Psychiatry 2001; 9: 382–90.
20Oudega, ML, van Exel, E, Stek, ML, Wattjes, MP, van der Flier, WM, Comijs, HC, et al. The structure of the geriatric depressed brain and response to electroconvulsive therapy. Psychiatry Res 2014; 222: 19.
21Ozkan Kuscu, O, Karacaer, F, Biricik, E, Gulec, E, Tamam, L, Gunes, Y. Effect of ketamine, thiopental and ketamine–thiopental combination during electroconvulsive therapy for depression. Turkish J Anesth Reanim 2015; 43: 313–7.
22Rhebergen, D, Huisman, A, Bouckaert, F, Kho, K, Kok, R, Sienaert, P, et al. Older age is associated with rapid remission of depression after electroconvulsive therapy: a latent class growth analysis. Am J Geriatr Psychiatry 2015; 23: 274–82.
23Schoeyen, HK, Kessler, U, Andreassen, OA, Auestad, BH, Bergsholm, P, Malt, UF, et al. Treatment-resistant bipolar depression: a randomized controlled trial of electroconvulsive therapy versus algorithm-based pharmacological treatment. Am J Psychiatry 2015; 172: 4151.
24Semkovska, M, Landau, S, Dunne, R, Kolshus, E, Kavanagh, A, Jelovac, A, et al. Bitemporal versus high-dose unilateral twice-weekly electroconvulsive therapy for depression (EFFECT-Dep): a pragmatic, randomized, non-inferiority trial. Am J Psychiatry 2016; 173: 408–17.
25Spaans, H-P, Verwijk, E, Comijs, HC, Kok, RM, Sienaert, P, Bouckaert, F, et al. Efficacy and cognitive side effects after brief pulse and ultrabrief pulse right unilateral electroconvulsive therapy for major depression: a randomized, double-blind, controlled study. J Clin Psychiatry 2013; 74: e102936.
26Spashett, R, Fernie, G, Reid, IC, Cameron, IM. MADRS symptom subtypes in ECT-treated depressed patients: relationship to response and subsequent ECT. J ECT 2014; 30: 227–31.
27van Waarde, Ja, van Oudheusden, LJB, Heslinga, OB, Verwey, B, van der Mast, RC, Giltay, E. Patient, treatment, and anatomical predictors of outcome in electroconvulsive therapy: a prospective study. J ECT 2013; 29: 113–21.
28Winkler, D, Pjrek, E, Lanzenberger, R, Baldinger, P, Eitel, D, Kasper, S, et al. Actigraphy in patients with treatment-resistant depression undergoing electroconvulsive therapy. J Psychiatr Res 2014; 57: 96100.
29Kellner, CH, Husain, MM, Knapp, RG, McCall, WV, Petrides, G, Rudorfer, MV, et al. Right unilateral ultrabrief pulse ECT in geriatric depression: phase 1 of the PRIDE study. Am J Psychiatry 2016; 173: 1101–9.
30Alves, LPC, Freire, TFV, Fleck, MPA, Rocha, NS. A naturalistic study of high-dose unilateral ECT among severely depressed inpatients: how does it work in the clinical practice? BMC Psychiatry 2016; 16; 396.
31Fink, M, Rush, aJ, Knapp, R, Rasmussen, K, Mueller, M, Rummans, Ta, et al. DSM melancholic features are unreliable predictors of ECT response: a CORE publication. J ECT 2007; 23: 139–46.
32Huuhka, K, Anttila, S, Huuhka, M, Leinonen, E, Rontu, R, Mattila, K, et al. Brain-derived neurotrophic factor (BDNF) polymorphisms G196A and C270T are not associated with response to electroconvulsive therapy in major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2007; 257: 31–5.
33Goldet, G, Howick, J. Understanding GRADE: an introduction. J Evid Based Med 2013; 6: 50–4.
34Stang, A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603–5.
35Trivedi, MH, Daly, EJ. Treatment strategies to improve and sustain remission in major depressive disorder. Dialogues Clin Neurosci 2008; 10: 377–84.
36Borenstein, M, Hedges, LV, Higgins, JPT, Rothstein, HR. Introduction to Meta-Analysis. John Wiley & Sons, Ltd, 2009.
37Higgins, J, Green, S. Cochrane Handbook for Systematic Reviews of Interventions. 5.1.0. Cochrane Collaboration, 2011.
38Egger, M, Davey Smith, G, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–34.
39Harbord, RM, Egger, M, Sterne, JAC. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 2006; 25: 3443–57.
40Egger, M, Smith, GD, Phillips, AN. Meta-analysis: principles and procedures. BMJ 1997; 315: 1533–7.
41Dannon, PN, Grunhaus, L. Effect of electroconvulsive therapy in repetitive transcranial magnetic stimulation non-responder MDD patients: a preliminary study. Int J Neuropsychopharmacol. 2001; 4: 265–8.
42De Vreede, IM, Burger, H, Van Vliet, IM. Prediction of response to ECT with routinely collected data in major depression. J Affect Disord 2005; 86: 323–7.
43Dombrovski, AY, Mulsant, BH, Haskett, RF, Prudic, J, Begley, AE, Sackeim, HA. Predictors of remission after electroconvulsive therapy in unipolar major depression. J Clin Psychiatry 2005; 66: 1043–9.
44Kho, KH, Zwinderman, AH, Blansjaar, BA. Predictors for the efficacy of electroconvulsive therapy: chart review of a naturalistic study. J Clinical Psychiatry 2005; 66: 894–9.
45Lin, C-H, Chen, M-C, Yang, W-C, Lane, H-Y. Early improvement predicts outcome of major depressive patients treated with electroconvulsive therapy. Eur Neuropsychopharmacol 2015; 26: 225–33.
46Loo, CK, Mahon, M, Katalinic, N, Lyndon, B, Hadzi-Pavlovic, D. Predictors of response to ultrabrief right unilateral electroconvulsive therapy. J Affect Disord 2011; 130: 192–7.
47Medda, P, Mauri, M, Toni, C, Mariani, MG, Rizzato, S, Miniati, M, et al. Predictors of remission in 208 drug-resistant depressive patients treated with electroconvulsive therapy. J ECT 2014; 30: 292–7.
48Okazaki, M, Tominaga, K, Higuchi, H, Utagawa, I, Nakamura, E, Noguchi, M, et al. Predictors of response to electroconvulsive therapy obtained using the three-factor structure of the montgomery and Asberg depression rating scale for treatment-resistant depressed patients. J ECT 2010; 26: 8790.
49Piccinni, A, Del Debbio, A, Medda, P, Bianchi, C, Roncaglia, I, Veltri, A, et al. Plasma brain-derived neurotrophic factor in treatment-resistant depressed patients receiving electroconvulsive therapy. Eur Neuropsychopharmacol 2009; 19: 349–55.
50Sivaprakash, B, Chandrasekaran, R, Sahai, A. Predictors of response to electro-convulsive therapy in major depression. Indian J Psychiatry 2000; 42: 148–55.
51Sobin, C, Prudic, J, Devanand, DP, Nobler, MS, Sackeim, HA. Who responds to electroconvulsive therapy? A comparison of effective and ineffective forms of treatment. Br J Psychiatry 1996; 169: 322–8.
52Tokutsu, Y, Umene-Nakano, W, Shinkai, T, Yoshimura, R, Okamoto, T, Katsuki, A, et al. Follow-up study on electroconvulsive therapy in treatment-resistant depressed patients after remission: a chart review. Clin Psychopharmacol Neurosci 2013; 11: 34–8.
53Tominaga, K, Okazaki, M, Higuchi, H, Utagawa, I, Nakamura, E, Yamaguchi, N. Symptom predictors of response to electroconvulsive therapy in older patients with treatment-resistant depression. Int J Gen Med 2011; 4: 515–9.
54Petrides, G, Fink, M, Husain, MM, Knapp, RG, Rush, AJ, Mueller, M, et al. ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. J ECT 2001; 17: 244–53.
55Cohen, J. Statistical Power Analysis for the Behavioral Sciences (2nd edn). Routledge, 1988.
56Parker, G. Defining melancholia: the primacy of psychomotor disturbance. Acta Psychiatr Scand 2007; 115 (suppl 433): 2130.
57Dierckx, B, Heijnen, WT, van den Broek, WW, Birkenhäger, TK. Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis. Bipolar Disord 2012; 14: 146–50.
58Heijnen, WT, Birkenhäger, TK, Wierdsma, AI, van den Broek, WW. Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: a meta-analysis. J Clin Psychopharmacol 2010; 30: 616–9.
59Nordenskjöld, A, von Knorring, L, Engström, I. Predictors of the short-term responder rate of Electroconvulsive therapy in depressive disorders--a population based study. BMC Psychiatry 2012; 12: 115.
60Sackeim, HA, Prudic, J, Devanand, DP, Nobler, MS, Lisanby, SH, Peyser, S, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry 2000; 57: 425–34.
61Sackeim, HA, Prudic, J, Nobler, MS, Fitzsimons, L, Lisanby, SH, Payne, N, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul 2008; 1: 7183.
62Leiknes, KA, Von Schweder, LJ, Høie, B. Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav 2012; 2: 283344.
63Tor, P, Bautovich, A, Wang, M, Martin, D, Harvey, SB, Loo, C. A systematic review and meta-analysis of brief versus ultrabrief right unilateral electroconvulsive therapy for depression. J Clin Psychiatry 2015; 76: e10928.
64Parker, G, McCraw, S. The properties and utility of the CORE measure of melancholia. J Affect Disord; 2017; 207: 128–35.
65Snowdon, J. Should psychomotor disturbance be an essential criterion for a DSM-5 diagnosis of melancholia? BMC Psychiatry 2013; 13: 160.
66Hickie, I, Mason, C, Parker, G, Brodaty, H. Prediction of ECT response: validation of a refined sign-based (CORE) system for defining melancholia. Br J Psychiatry 1996; 169: 6874.
67Fink, M, Edward, S, Donald, K, Jules, A, Koukopoulos, A, Carroll, B, et al. Melancholia: beyond DSM, beyond neurotransmitters. Proceedings of a conference, May 2006, Copenhagen, Denmark. Acta Psychiatr Scand Suppl 2007; 115: 4183.
68Rasmussen, KG. Do patients with personality disorders respond differentially to electroconvulsive therapy? A review of the literature and consideration of conceptual issues. J ECT 2015; 31: 612.
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Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis

  • Linda van Diermen (a1), Seline van den Ameele (a1), Astrid M. Kamperman (a2), Bernard C.G. Sabbe (a3), Tom Vermeulen (a3), Didier Schrijvers (a3) and Tom K. Birkenhäger (a4)...
  • Please note a correction has been issued for this article.
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