In this thesis the heterogeneity of late-life depression is being examined. The first part of the thesis focuses on data-driven analyses as a way of identifying subtypes of late-life depression.... Show moreIn this thesis the heterogeneity of late-life depression is being examined. The first part of the thesis focuses on data-driven analyses as a way of identifying subtypes of late-life depression. Through latent class analysis, we have identified three subtypes: a severe melancholic subtype, an atypical subtype, and a moderately severe subtype. These subtypes had different sociodemographic and clinical characteristics, but no specific biological disturbances could be addressed to the different subtypes. This is probably because of the tangle of (patho)physiological processes in aging itself, muddling the results. The stability of these subtypes over a two-year follow-up was however high, strengthening the clinical relevance of found subtypes.The second part of this thesis examines psychomotor disturbances in melancholic depression as a possible predicting symptom of response in electroconvulsive therapy. We have found that psychomotor disturbances predict to a certain amount the response to electroconvulsive therapy, but this effect was overruled by the predictive value of psychotic symptoms in depression. Finally, we have examined the speed of response of different depressive symptoms on electroconvulsive therapy in older depressed persons, and have found that all ten symptoms show response in two weeks, underlining the safety and efficacy of electroconvulsive therapy in older persons. Show less
Diermen, L. van; Vanmarcke, S.; Walther, S.; Moens, H.; Veltman, E.; Fransen, E.; ... ; Schrijvers, D. 2019
Psychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the... Show morePsychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the treatment modulates psychomotor disturbance. In 73 adults suffering from major depressive disorder psychomotor functioning was evaluated before, during and after ECT using the observer-rated CORE measure and objective measures including accelerometry and a drawing task. Regression models were fitted to assess the predictive value of melancholic depression (CORE >= 8) and the psychomotor variables on ECT outcome, while effects on psychomotor functioning were evaluated through linear mixed models. Patients with CORE-defined melancholic depression (n = 41) had a 4.9 times greater chance of reaching response than those (n = 24) with non-melancholic depression (Chi-Square = 7.5, P = 0.006). At baseline, both higher total CORE scores (AUC = 0.76; P = 0.001) and needing more cognitive (AUC = 0.78; P = 0.001) and motor time (AUC = 0.76; P = 0.003) on the drawing task corresponded to superior ECT outcomes, as did lower daytime activity levels (AUC = 0.76) although not significantly so after Bonferroni correction for multiple testing. A greater CORE-score reduction in the first week of ECT was associated with higher ECT effectiveness. ECT reduced CORE-assessed psychomotor symptoms and improved activity levels only in those patients showing the severer baseline retardation. Although the sample was relatively small, psychomotor symptoms were clearly associated with beneficial outcome of ECT in patients with major depression, indicating that monitoring psychomotor deficits can help personalise treatment. Show less
Dessens, F.M.; Paassen, J. van; Westerloo, D.J. van; Wee, N.J. van der; Vliet, I.M. van; Noorden, M.S. van 2016
Electroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to produce generalized seizure for the treatment of selected psychiatric disorders, mostly... Show moreElectroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to produce generalized seizure for the treatment of selected psychiatric disorders, mostly treatment resistant depression, acute mania, and schizophrenic syndromes. Safety of ECT increases the efficacy of therapy and provides fulfillment of a series of required treatments resulting in longer treatment effect of ECT. During the last few decades, researchers have been attempting to improve the effectiveness of ECT, to learn how and why it works, and to understand its risks and adverse side effects. As a result, the safety and efficacy of ECT has been improved and its indications have been relatively defined to increase the efficiency of outcome of therapy. While there has been considerable improvement in safety features, further investigation have been done to promote both the safety and efficacy of the treatment. Such efforts could increase our knowledge on the biological mechanisms involved in effectiveness of ECT that might result in discovery of new treatments. In this dissertation, we investigate how preprocedural medications could improve the safety and efficacy of ECT and further investigated the potential role of pharmacogenetics in the efficacy of ECT and procedural side effects such as cognitive disorders. Show less
The suffering of depressed patients is enormous. It also poses an important burden on their significant others and on society as a whole. Clinicians are therefore being urged to relieve these... Show moreThe suffering of depressed patients is enormous. It also poses an important burden on their significant others and on society as a whole. Clinicians are therefore being urged to relieve these conditions as soon as possible. To that purpose, effective psychotherapeutic, psychopharmacologic and other biological interventions, such as electroconvulsive therapy (ECT), are available. Observing a quick response to a course of ECT in a psychotic depressed patient is astonishing. ECT may restore the patient__s normal mood, but at the same time may provoke anxiety and a sense of shame or stigmatization. Frequently, ECT is accompanied by more or less impairing cognitive side effects. For clinicians and scientists, ECT is fascinating and raises many research questions concerning the effects of this treatment on the functioning of the brain. This thesis reports on our daily practice in which we treat severely ill depressed patients, while simultaneously doing clinical research. To further improve the understanding and the effectiveness of ECT, the electrical dose, which elicits the seizure activity (defined as seizure threshold [ST]), is the subject of this thesis Show less
