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Patients with Delusional Depression May Be Less Likely to Relapse After Electroconvulsive Therapy
A DGReview of :"One-Year Follow-Up After Successful ECT: A Naturalistic Study in Depressed Inpatients"
Journal of Clinical Psychiatry
02/11/2004
By Jill Taylor
The relapse rate up to 1 year after electroconvulsive therapy (ECT) may be lower for patients with delusional depression than in depressed patients without delusions, according to a new study.
Treatment of severe depression with ECT is highly effective, although relapse rates within 1 year of ECT discontinuation may be greater than 50%. Furthermore, post-ECT pharmacotherapy does not appear to effectively reduce relapse rates.
To examine the predictive value of pre-ECT pharmacotherapy and depression characteristics regarding post-ECT relapse, Tom K. Birkenhager, MD, of the Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands, and colleagues studied 40 inpatients with major depression who responded to ECT.
Among the subjects, 25 had delusional depression and 15 were depressed without delusions. Follow up for 1 year was performed prospectively for 28 patients and retrospectively for 12 patients. Relapse was defined as readmission, obvious decline in social functioning, or pharmacotherapy change due to worsening of depressive symptoms.
Overall, 59% of depressed patients remained well while continuing pharmacotherapy, and all relapses occurred in the first 8 months of follow up. Due to the low number of patients receiving inadequate pharmacotherapy prior to ECT, data regarding the impact of adequate pre-ECT antidepressant trials on relapse was inconclusive.
Surprisingly, the relapse rate in delusional patients was significantly lower than in non-delusional patients, at 6 months (12% vs. 53%, P = .03) and at 12 months (21% vs. 73%, P = .002) post-ECT.
"Since our study is descriptive rather than predictive, or findings regarding the more favourable 1-year outcome in delusional depression need to be confirmed by larger fully prospective studies," the investigators concluded.
J Clin Psychiatry 2004 Jan;65:1:87-91.
"One-Year Follow-Up After Successful ECT: A Naturalistic Study in Depressed Inpatients"
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