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- Nordenskjöld, Axel, 1977-, et al.
(author)
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Continuation Electroconvulsive Therapy With Pharmacotherapy Versus Pharmacotherapy Alone for Prevention of Relapse of Depression A Randomized Controlled Trial
- 2013
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In: Journal of ECT. - : Lippincott Williams & Wilkins. - 1095-0680 .- 1533-4112. ; 29:2, s. 86-92
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Journal article (peer-reviewed)abstract
- Objective: The primary aim of the study was to test the hypothesis that relapse prevention with continuation electroconvulsive therapy (ECT) plus pharmacotherapy is more effective than pharmacotherapy alone after a course of ECT for depression. Methods: A multicenter, nonblinded, randomized controlled trial with 2 parallel groups was performed from 2008 to 2012 in 4 hospitals in Sweden. Patients eligible had unipolar or bipolar depression and had responded to a course of ECT. The patients (n = 56) were randomly assigned (1: 1) to receiving either 29 treatments of continuation ECT with pharmacotherapy or pharmacotherapy alone for 1 year. The pharmacotherapy consisted of antidepressants (98%), lithium (56%), and antipsychotics (30%). The main outcome was relapse of depression within 1 year. Relapse was defined as 20 or more points on the Montgomery Asberg Depression Rating Scale or inpatient psychiatric care or suicide or suspected suicide. All 56 patients randomized were analyzed according to an intention to treat analysis. Results: Sixty-one percent of the patients treated with pharmacotherapy versus 32% of the patients treated with ECT plus pharmacotherapy relapsed within 1 year (P = 0.036). The Cox proportional hazard ratio was 2.32 (1.03-5.22). Cognitive function and memory measures were stable for patients without relapse in both groups. One suspected suicide and 3 suicide attempts by intoxication occurred, all in the pharmacotherapy-alone group. Conclusions: The post-ECT relapse rates were substantial in both treatment groups with a statistically significant advantage for combined treatment with pharmacotherapy and continuation ECT. Further studies are needed to define indications for continuation ECT, pharmacotherapy, and their combination.
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| 2. |
- Nordenskjöld, Axel, 1977-
(author)
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Electroconvulsive therapy for depression
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Aim: The overarching aims of the thesis were to identify clinical characteristics that predict the outcomes of depressed patients treated inclinical practice by ECT, and to elucidate the effectiveness of continuation ECT at preventing relapses and recurrences.Methods: The studies included a retrospective chart review, three studies based on a quality register for ECT, and a randomized controlled trial(RCT) examining the effectiveness of continued ECT.Results: The overall response rate to ECT was 80%. Patients with psychotic depression (89%), older patients (84%), and inpatients (83%) had the highest response rates. Patients with personality disorders (66%) and outpatients (66%) had the lowest response rates. With regard to patients on sick leave, 59%, 71% and 88% of patients regained occupational functioning 6, 12 and 24 months after ECT, respectively. The rate of hospitalisation after ECT was high, with rates of 25%, 34%and 44% 6, 12 and 24 months after ECT, respectively. The relapse rate was higher in patients that were taking benzodiazepines and lower in patients that were taking lithium.The relapse rate was significantly lower in patients treated with continued ECT in combination with pharmacotherapy (32%) than in those treated with pharmacotherapy alone (61%). This difference was particularly pronounced in medication-resistant patients (31% vs. 85%)Conclusions: The short-term response rate to ECT is relatively high in all patient subgroups, and is particularly high in older patients, inpatients and patients with severe depression. Patients often regain occupational functioning after ECT; however, this takes a considerably longer time than that required for symptom relief. Nevertheless, the relapse and recurrence rates of patients are high in the years after ECT. Continuation ECT and lithium treatment can be combined with antidepressants to reduce the risk of relapse and recurrence. Further RCTs are required to define the indications for continuation ECT and lithium treatment.
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| 3. |
- Nordenskjöld, Axel, 1977-, et al.
(author)
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Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder : a population based cohort study
- 2013
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In: Nordic Journal of Psychiatry. - Oxfordshire, United Kingdom : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 67:5, s. 326-333
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Journal article (peer-reviewed)abstract
- Aims: The aim of the present study is to investigate the rate of regained occupational functioning among patients treated with electroconvulsive therapy (ECT) for major depression and to define predictors of time to regained occupational functioning.Methods: A nested cohort study was performed of patients treated by ECT for unipolar major depressive disorder registered in the Quality register for ECT and in the Swedish Social Insurance Agency registry. Predictive values of single clinical variables and their relative importance were tested with Cox regression analysis.Results: 394 patients were identified. Of those, 266 were on non-permanent sick leave and 128 on disability pension during ECT. Within 1 year post-ECT, 71% of the patients with non-permanent sick leave regained occupational functioning. Factors independently associated with a statistically significant increased time to regained occupational functioning were longer duration of sick leave pre-ECT, milder depression pre-ECT, less complete improvement with ECT, benzodiazepine treatment after ECT and co-morbid substance dependence.Conclusions: A large proportion of the patients do not return to work within several months post-ECT. Paradoxically, patients with more severe depression pre-ECT had a reduced time to regained occupational functioning, indicating a larger effect in this patients group of the treatment. Moreover, the period with sick leave compensation might be reduced if ECT is initiated within the first 3 months of sick leave.Clinical implications: Most patients on non-permanent sick leave regain occupational functioning after ECT. However, it usually takes a few months even in symptomatically improved patients.
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