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Electroconvulsive therapy (ECT) is the most effective intervention for patients with treatment resistant depression. A clinical decision support tool could guide patient selection to improve the overall response rate and avoid ineffective treatments with adverse effects. Initial small-scale, monocenter studies indicate that both structural magnetic resonance imaging (sMRI) and functional MRI (fMRI) biomarkers may predict ECT outcome, but it is not known whether those results can generalize to data from other centers. The objective of this study was to develop and validate neuroimaging biomarkers for ECT outcome in a multicenter setting.
Multimodal data (i.e. clinical, sMRI and resting-state fMRI) were collected from seven centers of the Global ECT-MRI Research Collaboration (GEMRIC). We used data from 189 depressed patients to evaluate which data modalities or combinations thereof could provide the best predictions for treatment remission (HAM-D score ⩽7) using a support vector machine classifier.
Remission classification using a combination of gray matter volume and functional connectivity led to good performing models with average 0.82–0.83 area under the curve (AUC) when trained and tested on samples coming from the three largest centers (N = 109), and remained acceptable when validated using leave-one-site-out cross-validation (0.70–0.73 AUC).
These results show that multimodal neuroimaging data can be used to predict remission with ECT for individual patients across different treatment centers, despite significant variability in clinical characteristics across centers. Future development of a clinical decision support tool applying these biomarkers may be feasible.
Age alone is not a contraindication to any method of contraception. A reasonably common scenario in the mid-30s is that women who reach the age of 35 and smoke have to stop taking the combined oral contraceptive (COC) pill. A woman needs to consider whether to use a hormonal or non-hormonal method, whether she can commit to methods requiring daily, weekly, monthly or less frequent attention and which potential side effects she finds acceptable. The seven day pill-free interval (PFI) was chosen to ensure that the majority of women would start to bleed before they were due to start their next packet. In the context of postponing periods (as opposed to withdrawal bleeds), it is worth noting that new information has been incorporated into the Summary of Product Characteristics of PrimolutN, a commonly prescribed formulation of norethisterone 5mg, used for the postponement of periods in women not using COCs.
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