Evidence for increased genetic risk load for major depression in patients assigned to electroconvulsive therapy

Electroconvulsive therapy (ECT) is the treatment of choice for severe and treatment‐resistant depression; disorder severity and unfavorable treatment outcomes are shown to be influenced by an increased genetic burden for major depression (MD). Here, we tested whether ECT assignment and response/nonresponse are associated with an increased genetic burden for major depression (MD) using polygenic risk score (PRS), which summarize the contribution of disease‐related common risk variants. Fifty‐one psychiatric inpatients suffering from a major depressive episode underwent ECT. MD‐PRS were calculated for these inpatients and a separate population‐based sample (n = 3,547 healthy; n = 426 self‐reported depression) based on summary statistics from the Psychiatric Genomics Consortium MDD‐working group (Cases: n = 59,851; Controls: n = 113,154). MD‐PRS explained a significant proportion of disease status between ECT patients and healthy controls (p = .022, R² = 1.173%); patients showed higher MD‐PRS. MD‐PRS in population‐based depression self‐reporters were intermediate between ECT patients and controls (n.s.). Significant associations between MD‐PRS and ECT response (50% reduction in Hamilton depression rating scale scores) were not observed. Our findings indicate that ECT cohorts show an increased genetic burden for MD and are consistent with the hypothesis that treatment‐resistant MD patients represent a subgroup with an increased genetic risk for MD. Larger samples are needed to better substantiate these findings.     

Evidence of an early information processing speed deficit in unipolar major depression

BACKGROUND: Slowing of the speed of information processing has been reported in geriatric depression, but it is not clear if the impairment is present in younger patients, if motor retardation is responsible, or if antidepressant medications play a role. METHOD: Twenty unmedicated unipolar depressed inpatients were compared with 19 medicated depressed in-patients and 20 age-, sex- and verbal IQ-matched controls on inspection time (IT), a measure of speed of information processing that does not require a speeded motor response. We also examined the relationship between IT and current mood and length of depressive illness. RESULTS: Unmedicated depressed patients showed slowing of information processing speed when compared to both medicated depressed patients and controls. The latter two groups were not significantly different from each other. Slowing of IT was not associated with current mood, but was negatively correlated with length of illness since first episode. No differences in IT were found between patients receiving medication with anticholinergic effects and patients receiving medication with no anticholinergic effects. CONCLUSIONS: The findings indicate that unipolar depression is associated with a slowing of speed of information processing in younger patients who have not received antidepressant medication. This does not appear to be a result of motor slowing.     

Influence of episode duration of major depressive disorder on response to electroconvulsive therapy

BACKGROUND: Longer duration of major depressive episode is supposed to decrease response to electroconvulsive therapy (ECT). Most studies on the subject are dated and their population differs from ours, therefore their results may not be applicable to our population of severely depressed inpatients. METHODS: We reviewed the records of 56 consecutive inpatients with major depressive disorder according to DSM-III-R criteria and assessed each patient's episode duration. We examined whether episode duration has an effect on response to ECT. RESULTS: Episode duration has no significant effect on response to ECT, according to both a reduction on the Hamilton Rating Scale for Depression (HRSD) of at least 50% and a post-treatment HRSD score 相似文献   

ECT response in delusional versus non-delusional depressed inpatients

BACKGROUND: ECT is often considered more effective in delusional than in non-delusional depressives, although the literature does not support this view. METHODS: We reviewed the records of 55 consecutive inpatients with major depression according to the DSM-III-R criteria and distinguished two subtypes: patients with delusions and those without. We examined whether the deluded patients showed a higher response rate. RESULTS: using 50% reduction on the Hamilton Rating Scale for Depression (HRSD) as response criterion, the efficacy of ECT was higher in patients with delusional depression (92% response) than in the non-deluded patients (55% response). Considering a post-ECT HRSD score of < or =7 as response criterion, patients with delusions again showed a higher response rate (57% versus 24%). LIMITATIONS: this study has a retrospective nature and a rather homogeneous sample. CONCLUSION: ECT appears to be an effective treatment for severely depressed inpatients, both with and without delusions. The efficacy of ECT was superior in patients with delusional depression, considering the number of patients achieving partial remission as well as full remission.     

Does power matter with ECT?

BACKGROUND: To assess the incidence of depressed inpatients requiring high output ECT and the response of this group compared with a group requiring standard output ECT. METHODS: We reviewed the records of 59 consecutive inpatients that were treated with bilateral ECT between January 2001 and January 2004. Diagnosis of major depression was based on DSM IV criteria. Response and remission to ECT (respectively defined as a 50% reduction in score and a score of < or = 7 on the Hamilton Rating Scale for Depression; HRSD) of both groups were compared. RESULTS: Of the 59 patients, 13 (22%) required high output ECT. These patients needed significantly more ECT treatments than patients in the standard dose group (16.4+/-7.1 versus 10.4+/-4.5; p=0.01). In total, 31 of 46 patients (67%) requiring standard output ECT and 11 of the 13 patients (85%) requiring high output ECT responded to ECT. This difference is not significant. LIMITATIONS: This study has a retrospective nature and a rather homogenous sample. CONCLUSION: In this study 1 in 5 of the depressed inpatients needs a high dose energy of bilateral ECT to induce an adequate seizure. The efficacy of ECT in these patients is similar to that in the standard dose group. Considering these facts, high output ECT devices should be available for use in routine clinical practice.     

Cluster C personality disorder impedes alleviation of symptoms in major depression

BACKGROUND: We investigated whether cluster C personality disorder (CPD) is associated with recovery from depression. METHODS: The study design was observational. Diagnoses of major depression (MD) and CPD were confirmed by means of the Structured Clinical Interview for DSM-III-R (SCID-I, -II). Changes in symptom scales in 52 patients with MD and CPD were compared with changes in 65 patients with MD alone over a 6-month follow-up period. RESULTS: On the Hamilton Depression Rating Scale and Beck Depression Inventory (BDI) scales, recovery of patients with MD and comorbid CPD was inferior to recovery of patients with MD alone. Findings were similar in relation to several other symptom scales. Of those with MD alone 54% had recovered from their depression, but only 16% of those with CPD and MD (BDI score <10 on follow-up). Logistic regression analysis revealed an independent association between lack of recovery and presence of CPD (OR 7.5, 95% CI 2.6-22.2). LIMITATIONS: Study design was observational. CONCLUSION: The presence of CPD hinders alleviation of depressive symptoms in major depression.     

无抽搐电痉挛与电痉挛治疗对记忆影响的对照研究

目的：探讨无抽搐电痉挛对记忆的影响。方法：将入组病例随机分为两组，分别施行无抽搐电痉挛治疗与电痉挛治疗，以修订韦氏记忆量表（ＷＭＳ）与简明精神病评定量表（ＢＰＲＳ）作为评定工具，比较两组之间的记忆水平及疗效。结果：无抽搐电痉挛对记忆无明显影响，电痉挛对记忆的影响持续两周以上，电痉挛对记忆的影响可能与大脑短时间缺氧有关。结论无抽搐电痉挛不影响患者记忆，治疗时患者不感到痛苦，易于接受，可替代电痉挛治疗     

Racial differences in the availability and use of electroconvulsive therapy for recurrent major depression

BackgroundBlack Americans with depression were less likely to receive electroconvulsive therapy (ECT) than whites during the 1970s and 80s. This pattern was commonly attributed to treatment of blacks in lower quality hospitals where ECT was unavailable. We investigated whether a racial difference in receiving ECT persists, and, if so, whether it arises from lesser ECT availability or from lesser ECT use within hospitals conducting the procedure.MethodsBlack or white inpatient stays for recurrent major depression from 1993 to 2007 (N = 419,686) were drawn from an annual sample of US community hospital discharges. The marginal disparity ratio estimated adjusted racial differences in the probabilities of (1) admission to a hospital capable of conducting ECT (availability), and (2) ECT utilization if treated where ECT is conducted (use).ResultsAcross all hospitals, the probability of receiving ECT for depressed white inpatients (7.0%) greatly exceeded that for blacks (2.0%). Probability of ECT availability was slightly greater for whites than blacks (62.0% versus 57.8%), while probability of use was markedly greater (11.8% versus 3.9%). The white versus black marginal disparity ratio for ECT availability was 1.07 (95% confidence interval 1.06–1.07) and stable over the period, while the ratio for use fell from 3.2 (3.1–3.4) to 2.5 (2.4–2.7).LimitationsDepressed persons treated in outpatient settings or receive no care are excluded from analyses.ConclusionsDepressed black inpatients continue to be far less likely than whites to receive ECT. The difference arises almost entirely from lesser use of ECT within hospitals where it is available.     

Short-term prognosis in primary and secondary major depression

Among inpatients treated without ECT, those with primary unipolar depression had significantly better outcomes at discharge than did those with secondary depression. This difference grew more striking during a 6-month follow-up; patients with secondary depression were clearly less likely to recover from the index depressive episode and had substantially higher symptom levels at the time of follow-up. In contrast, patients with DSM-III melancholia resembled depressed patients without melancholia on all outcome measures.     

A prospective follow-up study of ECT outcome in older depressed patients

BACKGROUND: This study examined the relationship between age and outcome of electroconvulsive therapy (ECT). METHOD: This was a naturalistic, prospective follow-up of 81 consecutive in-patients with primary major depression. ECT outcome was compared for three age groups - under 65, 65-74 and 75 years and over - on the Hamilton Rating Scale for Depression (HRSD), Global Assessment of Functioning scale (GAF) and clinical outcome rating scale. Assessments were performed pre-ECT, immediately post-ECT, 1-3 years later and, for patients suspected of having dementia, 5 years later. RESULTS: At post-ECT and follow-up, improvement on HRSD and clinical outcome ratings were comparable for patients in the three age groups. Improvements on GAF were also comparable post-ECT, but not between post-ECT and follow-up. At follow-up, 35.7% of the oldest group had dementia. Importantly, patients who did and did not develop dementia were clinically indistinguishable prior to ECT. The number and severity of common adverse events were similar pre- and post-ECT and were not associated with age. CONCLUSIONS: Depressive outcome and adverse effects of ECT are largely independent of age. Older patients receiving ECT appear to have a higher risk of developing dementia, possibly underpinned by cerebrovascular disease.     

Stability and change in level of maternal depressive symptomatology during the first postpartum year

BACKGROUND: This study evaluated stability and change in the level of maternal depressive symptomatology over the course of the first postpartum year in a community cohort of 106 first-time mothers of full-term, healthy infants. Effects of diagnosed depression and infant gender were also assessed. METHODS: At 2 months postpartum (intake), mothers were classified into one of two symptom groups on the basis of their total score on the Center for Epidemiological Studies-Depression Scale (CES-D): high (CES-D score > or = 16, 46%) or normative (CES-D score = 2-12, 54%). Mothers completed the CES-D again at 3, 6, and 12 months postpartum. At 12 months, maternal diagnostic status for major depression and related disorders was evaluated using the Diagnostic Interview Schedule-III-Revised. RESULTS: Mothers in the High symptom group at intake continued to have significantly higher CES-D scores at 3, 6, and 12 months than mothers in the Normative symptom group at intake, and a third in the High symptom group at intake had a subsequent CES-D score above the clinical cutoff (> or = 16). Maternal CES-D scores were significantly correlated across visits. In regressions controlling for diagnostic status and infant gender, mothers' CES-D score at the most recent prior assessment contributed significant unique variance to mothers' CES-D score at each subsequent assessment. CES-D scores were higher at 3 months if mothers had diagnosed depression and were parenting a son, and higher at 12 months if mothers had both diagnosed depression and a prior, high CES-D score. LIMITATIONS: Findings may not generalize to multipara or high-risk cohorts. CONCLUSIONS: First-time mothers with high levels of depressive symptomatology at 2 months postpartum (especially those with diagnosed depression) are at increased risk of continuing to experience high levels of depressive symptomatology throughout the first postpartum year. Implications for preventative intervention services are discussed.     

The effect of ECT on the perception of emotion in depressed patients.

35 psychiatric inpatients with diagnosed with unipolar or bipolar depression were given tests of memory, depression, and affective aprosody prior to the initiation of pulse unilateral nondominant ECT. Following ECT treatment, patients were given the same battery of tests using alternate forms of the same tests. The results of this study showed significant treatment effects in all three dependent variables without significant interaction between variables. The implications of these findings were discussed.     

Clinical efficacy and cognitive side effects of bifrontal versus right unilateral electroconvulsive therapy (ECT): a short-term randomised controlled trial in pharmaco-resistant major depression

BACKGROUND: In most studies right unilateral electroconvulsive therapy (ECT) has been shown to cause fewer cognitive side effects but less antidepressant efficacy compared with bi(fronto)temporal ECT at certain intensities. AIMS: To compare the short-term efficacy and side effects of right unilateral ECT and bifrontal ECT. METHODS: In a double-blind randomised controlled clinical trial, 92 patients diagnosed with pharmaco-resistant major depression received either six right unilateral ECT treatments (250% stimulus intensity of titrated threshold) or six bifrontal ECT (150% of threshold) treatments over a 3-week period. Concomitant psychotropic medications were continued during ECT treatments. The severity of depression and cognitive status was assessed prior to the first ECT and one day after the sixth ECT using the 21-item Hamilton Depression Rating Scale and the modified Mini Mental State Examination. RESULTS: Eight patients did not complete the course of the study due to minor side effects or withdrawal of consent. The mean Hamilton Depression score decreased from 27 to 17 points in both groups of 46 patients, resulting in 12 responders (primary endpoint defined as a decrease >50%) in each patient group (95% confidence interval for the odds ratio from 0.35 to 2.8). There was no reduction in the modified Mini Mental State score (mean score 86 of 100 points). CONCLUSIONS: Both bifrontal and right unilateral electrode placements in ECT were reasonably safe and moderately efficacious in reducing symptoms of pharmaco-resistant major depression.     

Validity of adjustment disorder, comparison with major depression

Twenty inpatients suffering from an adjustment disorder with depressed mood according to the DSM-III criteria were compared with 22 inpatients with a (situationally provoked) major depression without an additional DSM-III/axis I diagnosis, with regard to expert- and self-rated symptomatology, social dysfunction and personality features. Furthermore, social support prior to admission was described. Subjects who had developed an adjustment disorder had less severe depressive symptomatology, associated social dysfunction and premorbid rigidity, and they remitted faster. Social support for both groups was similar to that of healthy controls.     

癌症患者的抑郁特点及相关因素

目的 :探讨癌症患者抑郁情绪的特点及其相关因素。方法 :用自编一般情况问卷、Beck抑郁问卷 (BDl)、中国传统价值观问卷及简易应对方式问卷 (CPS)对 10 0例癌症患者及采用BDI对 62例抑郁症患者评估。结果 :10 0例癌症患者分为癌症抑郁组 ( 65例 )和癌症非抑郁组 ( 3 5例 )。抑郁组抑郁总分及抑郁、失败感、悲观、不满、自我失望感、自杀意向、活动抑制、自责、社会退缩九因子均分低于抑郁症组(P <0 0 1) ;癌症抑郁患者道家价值观及正性应对方式均分低于癌症非抑郁组 (P <0 0 1)。以是否抑郁为因变量 ,对有关变量进行Logistic回归分析 ,卡氏评分、P分、疼痛、工作应激及知情变量依次进入方程。结论 :癌症患者抑郁程度较抑郁症患者轻 ,主要表现为精神及躯体运动抑制 ,生物学症状不具鉴别价值。癌症抑郁的发生与卡氏评分、P分、疼痛、工作应激及知情等相关。     

The views and outcomes of consenting and non-consenting patients receiving ECT

BACKGROUND: Current mental health legislation in the UK makes provision for the use of certain treatments in severely ill patients who are unable, or unwilling, to give informed consent. Under the terms of this legislation, electroconvulsive therapy (ECT) may be used, usually to treat severely depressed patients. A number of organizations have challenged this practice, stating that ECT should only be given with fully informed consent: it has been implied that patients receiving compulsory ECT (given without the patient's consent, under the terms of mental health legislation) find the treatment damaging and unhelpful. METHODS: A series of 150 patients receiving ECT in Aberdeen was studied. A proportion of the series (approximately 7%) received compulsory ECT. The views and treatment outcomes of compulsory patients were compared with those of patients giving informed consent for treatment. RESULTS: More than 80% of patients in both consenting and compulsory groups considered ECT to have helped them. Clinical outcome did not differ between the groups. Patients' views showed marked concordance with independent medical evaluation of outcome. CONCLUSIONS: Outcome following ECT in non-consenting patients is equivalent to that seen in consenting patients whether rated by the patients themselves or by clinicians. Overall outcome is good, with more than 80% of patients benefiting from treatment. A ban on compulsory ECT would deny the access of seriously ill patients to an effective and acceptable treatment.     

Absence of interactions between social support and stressful life events in the prediction of major depression and depressive symptomatology in women

BACKGROUND: While high levels of social support (SS) are associated with a decreased risk for major depression (MD) or less depressive symptomatology, and stressful life events (SLEs) have a substantial causal relationship with MD, uncertainty remains as to whether a main-effect or a buffering model best explains the nature of the relationship among SS, MD and SLEs. METHOD: Using two waves of interview data on 2,163 female twin pairs from a population-based twin registry, and discrete time survival analysis with both logistic and linear regression models, we examine the ability of interactions between eight dimensions of SS and 16 categories of stressful life events to predict MD onset and levels of depressive symptomatology. RESULTS: In the presence of a significant effect of a SLE on MD (beta > or = 100), we found evidence for seven interactions out of a possible 93, of which none involved buffering effects. Similarly, examination of depressive symptomatology detected a total of two interactions (both buffering) out of possible 28. We found no evidence, beyond what would be expected by chance, for the existence of buffering effects where either MD or depressive symptomatology was used as the dependent variable. CoNCLUSIONS: There is little evidence to suggest the presence of the buffering effect of social support in the face of adverse life events for women. We suggest that it is important to use alternative models (multiplicative and additive) to examine data, to investigate the match between stressors and social resources, and to investigate fully whether detected interactions actually represent a buffering effect.     

Pterin metabolism in depression: an extension of the amine hypothesis and possible marker of response to ECT.

Urinary excretion of neopterins and biopterins was measured in 23 patients with severe depression before and after receiving electroconvulsive therapy (ECT) and 26 healthy control subjects. Patients with psychotic depression and those responding to ECT had neopterin:biopterin (N:B) ratio significantly higher than controls before commencing ECT and positive therapeutic response was associated with reduction of N:B ratio towards control values. As a raised N:B ratio implies failure to convert neopterin to biopterin it is possible that reduced availability of tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, serotonin and dopamine, may exert rate limiting control over the synthesis of monoamines implicated in the pathogenesis of depressive disorders. The N:B ratio may be a marker for certain depressive subtypes and response to ECT.     

Influence of resistance to antidepressant pharmacotherapy on short-term response to electroconvulsive therapy

BACKGROUND: Few studies assessing the influence of resistance to antidepressant pharmacotherapy on the response to subsequent electroconvulsive therapy (ECT) are found in the literature. Results are somewhat conflicting and may not be applicable to the population of depressed patients in The Netherlands. The aim of this study is to assess the influence of medication resistance on the short-term response to ECT in a population of severely depressed inpatients in The Netherlands, where ECT is an exceptional treatment, often used as a final treatment option. METHODS: We reviewed the records of 41 consecutive inpatients with major depression according to DSM-III-R criteria and rated each patients' antidepressant pharmacotherapy prior to ECT. We examined the extent to which medication resistance was related to short-term response to ECT. RESULTS: When a reduction of at least 50% on the Hamilton Rating Scale for Depression (HRSD) post-ECT compared to pre-ECT (partial remission) is used as response criterion, medication resistant patients and patients without established medication resistance were equally likely to respond to subsequent ECT. When a post-ECT HRSD score < or = 7 (full remission) is used as response criterion, medication resistant patients were less likely to respond to subsequent ECT (8/29=27.6%) than patients who did not receive adequate antidepressant pharmacotherapy prior to ECT (6/12=50.0%), although the difference in response rate was not statistically significant. LIMITATIONS: This study has a retrospective nature and a relatively small sample size. CONCLUSION: Antidepressant medication resistance does not seem to have an influence on the short-term response to subsequent ECT. However, when the number of patients achieving full remission is concerned, a substantial percentage of antidepressant medication resistant patients respond to ECT, although their response rate was nearly half compared to that of patients without prior adequate treatment with antidepressants. This difference in response rate was not statistically significant. ECT seems to be an effective treatment for both patients with and without prior adequate treatment with antidepressants in this Dutch population.