Objectives In clinical practice, particularly melancholic depression benefits from electroconvulsive therapy (ECT), albeit research melancholia criteria from the Diagnostic and Statistical Manual... Show moreObjectives In clinical practice, particularly melancholic depression benefits from electroconvulsive therapy (ECT), albeit research melancholia criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) is not conclusive. We compared clinical characteristics and ECT outcome of melancholic and nonmelancholic depression, here defined by psychomotor symptoms. Methods One hundred ten depressed older in-patients treated with ECT were included in the Mood Disorders in Elderly treated with ECT study. The CORE was used for the assessment of psychomotor symptoms, with a score of 8 or higher defining melancholic depression. Depression severity was measured before, during, and after ECT. Characteristics were compared across melancholic and nonmelancholic patients. Regression analysis was used to assess the relation between psychomotor symptoms and remission/response, and survival analysis was used to examine the difference in time. Results Patients with melancholic depression had higher severity, lower cognitive and overall functioning, and lower prevalence of cardiovascular disease. However, no significant relations were found between CORE scores and remission/response. Because psychotic symptoms are a positive predictor of ECT response and remission, we examined whether CORE score was a predictor of response in the nonpsychotic group (n = 49). In nonpsychotic patients, remission was 62%, and the association between CORE scores and remission almost reached significance (P = 0.057). Discussion Although melancholically and nonmelancholically depressed patients differed significantly on several clinical characteristics, ECT outcome did not differ. Analyses may be hampered by a high prevalence of psychotic features. In nonpsychotic patients, CORE scores neared significance as predictor of remission, suggesting that CORE scores might be a distinguishing characteristic of melancholia in nonpsychotic patients and a clinical useful predictor of ECT response. Show less
Veltman, E.M.; Boer, A. de; Dols, A.; Exel, E. van; Stek, M.L.; Sienaert, P.; ... ; Rhebergen, D. 2019
Introduction: Electroconvulsive therapy (ECT) is an important and effective treatment for depression. However, research on course trajectories of depressive symptoms during ECT is limited. Insight... Show moreIntroduction: Electroconvulsive therapy (ECT) is an important and effective treatment for depression. However, research on course trajectories of depressive symptoms during ECT is limited. Insight into putative differences in speed of response of depressive symptom dimensions may enable clinicians to optimally informpatients and their relatives. Therefore, we aim to examine course trajectories of depressive symptom dimensions in depressed older persons during ECT.Methods: Data were derived from the Mood Disorders in Elderly treated with Electro Convulsive Therapy study, including 110 persons, aged 55 years or more, with a current diagnosis of major depressive disorder and referred for ECT. Exploratory factor analysis was used to identify symptom dimensions, using the 10 depression items of the Montgomery-Asberg Depression Rating Scale (MADRS). Differences in course trajectories of symptom dimension during 2 weeks were examined by multilevel analyses.Results: Three symptom dimensionswere identified: a "mood," "melancholic," and "suicidal" dimension. Mood showed a significantly greater severity decline as compared with melancholic and suicidal at the 1-week follow-up. At the 2-week follow-up, both mood and melancholic demonstrated a significantly greater decline as compared with suicidal. However, because scores on the suicidality item of the Montgomery-Asberg Depression Rating Scale were already lower at baseline compared with the other items, a floor effect cannot be ruled out.Discussion: All symptom dimensions of depression showed a rapid response to ECT. Our findings did not support the general assumption that suicidal symptoms may be the first to improve. However, a floor effect on the suicidality item cannot be ruled out. Show less
Veltman, E.M.; Hulten, S. van; Twisk, J.; Dols, A.; Exel, E. van; Stek, M.L.; ... ; Rhebergen, D. 2019
Introduction Electroconvulsive therapy (ECT) is an important and effective treatment for depression. However, research on course trajectories of depressive symptoms during ECT is limited. Insight... Show moreIntroduction Electroconvulsive therapy (ECT) is an important and effective treatment for depression. However, research on course trajectories of depressive symptoms during ECT is limited. Insight into putative differences in speed of response of depressive symptom dimensions may enable clinicians to optimally inform patients and their relatives. Therefore, we aim to examine course trajectories of depressive symptom dimensions in depressed older persons during ECT.Methods Data were derived from the Mood Disorders in Elderly treated with Electro Convulsive Therapy study, including 110 persons, aged 55 years or more, with a current diagnosis of major depressive disorder and referred for ECT. Exploratory factor analysis was used to identify symptom dimensions, using the 10 depression items of the Montgomery-Åsberg Depression Rating Scale (MADRS). Differences in course trajectories of symptom dimension during 2 weeks were examined by multilevel analyses.Results Three symptom dimensions were identified: a “mood,” “melancholic,” and “suicidal” dimension. Mood showed a significantly greater severity decline as compared with melancholic and suicidal at the 1-week follow-up. At the 2-week follow-up, both mood and melancholic demonstrated a significantly greater decline as compared with suicidal. However, because scores on the suicidality item of the Montgomery-Asberg Depression Rating Scale were already lower at baseline compared with the other items, a floor effect cannot be ruled out.Discussion All symptom dimensions of depression showed a rapid response to ECT. Our findings did not support the general assumption that suicidal symptoms may be the first to improve. However, a floor effect on the suicidality item cannot be ruled out. Show less
Groeneweg-Koolhoven, I.; Ploeg, M.; Comijs, H.C.; Penninx, B.W.J.H.; Mast, R.C. van der; Schoevers, R.A.; ... ; Exel, E. van 2017
Objective: Electroconvulsive therapy (ECT) is a valuable treatment option in severely depressed elderly patients. Structural abnormalities in the brain, such as white matter hyperintensities,... Show moreObjective: Electroconvulsive therapy (ECT) is a valuable treatment option in severely depressed elderly patients. Structural abnormalities in the brain, such as white matter hyperintensities, medial temporal lobe atrophy (MTA), or global cortical atrophy, may influence therapeutic response. The respective value of these factors in response prediction is unclear. Method: In a naturalistic clinical cohort of 81 elderly patients diagnosed with DSM-IV major depressive disorder, magnetic resonance imaging (MRI) was recorded and rated before ECT treatment. The study was conducted at the Clinic for Geriatric Psychiatry of the VU University Medical Center/Stichting Buitenamstel Geestgronden, Amsterdam, The Netherlands, over a 5-year period (2001-2006). Severity of depressive symptoms was measured by using the Montgomery-Asberg Depression Rating Scale (MADRS). Response to ECT was defined as a decrease of at least 50 percent on the MADRS, and remission was defined as a score below 10 points on the MADRS. Results: Patients with moderate or severe MTA had a lower mean percentage decrease in MADRS scores after ECT (37.9% in those with MTA, compared to 66.2% in those without MTA, P = .008). Patients without MTA had a 3 times greater chance of remitting from their depression compared to patients with moderate or severe MTA, ie, the hazard ratio for remission was 3.22 (95% CI, 1.30 to 7.69, P=.01). In contrast, no differences in change in MADRS scores were found for white matter hyperintensities or global cortical atrophy. Conclusions: Medial temporal lobe atrophy not white matter hyperintensities or global cortical atrophy contributes to poor response to ECT in severely depressed elderly patients. These findings suggest that assessment of MTA in severely depressed elderly patients may be useful in the prediction of potential ECT response. J Cllin Psychiatry 2011;72(1):104-112 (C) Copyright 2010 Physicians Postgraduate Press, Inc. Show less
