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Effectiveness and safety of electroconvulsive therapy and its predictors

Keywords:
depression electroconvulsive therapy prediction

Researchers:
B.C.M. Haarman
S.M. van Belkum
J.G. Warning
M. Vischjager

Nature of the research:
Archival cohort study

Fields of study:
psychiatry

Background / introduction
Electroconvulsive therapy (ECT) offers an effective treatment for depression with remission rates up to 50-80%, even in treatment-resistant depression (Dierckx et al 2012, Husain et al 2004). However, its cognitive side-effects are a major barrier for patients, relatives and professionals. The effect sizes of psycho- and pharmacotherapy are smaller, with psychotherapy being relatively costly and pharmacotherapy having side-effects too.
In the stepped care model, there is a tendency to regard ECT as a last resort therapy, which may unintentionally have contributed to a severe gap between patients who would benefit from ECT and patients actually receiving ECT, as only 1.2 % of all Dutch patients with chronic depression received ECT (Scheepens et al, 2019).
We propose to investigate the predictors of response and safety in a newly created dataset, that will be derived from ECT data that is collected in medical files The dataset will also contribute to the Dutch ECT Cohort (DEC), a collection of data of all large Dutch health care institutions. The results will inform both patients and professionals on the optimal timing of ECT for an individual patient. Identified predictors of remission and cognitive side-effects will allow patients, their relatives and professionals to come to an informed shared decision on the start of ECT. Immediate impact on Dutch ECT guidelines is to be expected.
Research question / problem definition
We have two aims: (1) investigate the effectiveness of ECT and determine its clinical predictors, (2) investigate cognitive side-effects of ECT and determine its clinical predictors.
Our results will contribute to indicate which depressed patients should receive ECT in a relatively early treatment stage, an important contribution in the era of precision medicine. In addition, reliable predictors for cognitive side-effects with ECT will improve treatment selection by predicting an individual's expected balance between mood improvement and cognitive complaints.
Workplan
Data will be collected from the patients' medical files.
Data will be analyzed and reported.
References
Dierckx, B., W. T. Heijnen, W. W. van den Broek and T. K. Birkenhager (2012). "Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis." Bipolar Disord 14(2): 146-150.
Husain, S. S., I. M. Kevan, R. Linnell and A. I. Scott (2004). "Electroconvulsive therapy in depressive illness that has not responded to drug treatment." J Affect Disord 83(2-3): 121-126.
Scheepens, D. S., J. A. van Waarde, A. Lok ....G. A. van Wingen (2019). "[Electroconvulsion therapy for persistent depression in the Netherlands; very low application rate]." Tijdschr Psychiatr 61(1): 16-21.
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