Hypothalamic-pituitary-adrenal axis abnormality and ECT response

Response to electroconvulsive therapy (ECT) was assessed in 42 depressed patients grouped by dexamethasone suppression test (DST) response. Patients with initially abnormal DST results had better outcomes according to global ratings that did patients with initially normal DST results; final Hamilton Rating Scale scores did not distinguish these two groups, however. No group had an outcome that was clearly poor; only three (14.3%) patients with initially normal DST results were rated as unimproved at discharge. The results of this and other studies attempting to predict response to ECT are sensitive to the heterogeneity of patients referred for ECT, the timing and type of outcome assessment, and the differential action of placebo effects.