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The impact of treatment resistance on outcome and course of electroconvulsive therapy in major depressive disorder.
Rovers, J J E; Vissers, P; Loef, D; van Waarde, J A; Verdijk, J P A J; Broekman, B F P; Vergouwen, A C M; Oudega, M L; van Exel, E; Coenen, R; Everaerd, D S; Tendolkar, I; Dols, A; van Eijndhoven, P F P.
Afiliación
  • Rovers JJE; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.
  • Vissers P; Department of Psychiatry, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
  • Loef D; GGZ Breburg, Tilburg, The Netherlands.
  • van Waarde JA; Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, The Netherlands.
  • Verdijk JPAJ; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.
  • Broekman BFP; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands.
  • Vergouwen ACM; Department of Psychiatry, Rijnstate Depression Center, Arnhem, The Netherlands.
  • Oudega ML; Department of Psychiatry, Rijnstate Depression Center, Arnhem, The Netherlands.
  • van Exel E; Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands.
  • Coenen R; Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, The Netherlands.
  • Everaerd DS; Department of Psychiatry and Medical Psychology, OLVG Hospital, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.
  • Tendolkar I; Department of Psychiatry and Medical Psychology, OLVG Hospital, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.
  • Dols A; Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, The Netherlands.
  • van Eijndhoven PFP; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands.
Acta Psychiatr Scand ; 147(6): 570-580, 2023 06.
Article en En | MEDLINE | ID: mdl-37020420
INTRODUCTION: Major depressive disorder (MDD) is a common psychiatric disorder. Despite several treatment options, a subgroup of patients will not respond to the commonly used antidepressant treatments and thus express treatment resistance (TRD). TRD can be quantified with the Dutch Measure for Treatment Resistance in Depression (DM-TRD). Electroconvulsive therapy (ECT) is an effective treatment for MDD, also in TRD. Yet, the position of ECT as "treatment-of-last-resort" may decrease the likelihood of beneficial outcome. Our aim was to investigate the association between treatment resistance and outcome and course of ECT. METHODS: We performed a retrospective, multicenter cohort study with 440 patients of which data was retrieved from patient records as collected in the Dutch ECT Cohort database. Linear and logistic regression models were used to explore the association between level of treatment resistance and outcome of ECT. Median split was used to explore the differences between high and low level of TRD and course of treatment. RESULTS: A higher DM-TRD score was associated with significantly smaller reduction of depression symptoms (R2 = 0.160; ß = -2.968; p < 0.001) and lower chance of response (OR = 0.821 [95 CI: 0.760-0.888]; ß = -0.197; p < 0.001). Low level TRD patients underwent fewer ECT sessions (mean 13 ± 6 SD vs. 16 ± 7 SD; p < 0.001) and fewer switches from right unilateral tot bifrontotemporal electrode placement (29% vs. 40%; p = 0.032). CONCLUSION: Reserving ECT as "treatment-of-last-resort" in the treatment algorithm for MDD seems questionable, because in our study lower level of treatment resistance predicted more beneficial ECT-outcome. Moreover, providing ECT in less treatment resistant patients showed fewer needed ECT-sessions and less switches to BL electrode placement, which may decrease the risk for cognitive side-effects.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trastorno Depresivo Mayor / Terapia Electroconvulsiva / Trastorno Depresivo Resistente al Tratamiento Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Acta Psychiatr Scand Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trastorno Depresivo Mayor / Terapia Electroconvulsiva / Trastorno Depresivo Resistente al Tratamiento Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Acta Psychiatr Scand Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos