FROM JOURNAL OF AFFECTIVE DISORDERS
A long recovery from disorientation following electroconvulsive therapy (ECT) seems to be a sign that the therapy has effectively treated an elderly patient with major depression, suggests a longitudinal cohort study conducted in Norway.
The study comprised 57 Norwegian-speaking inpatients, aged 60-85 years, who had major depressive disorders. To enter the study, a patient needed to have a minimum baseline score of 18 on the 17-item Hamilton Rating Scale for Depression (HRSD17). Among the study’s exclusion criteria were a diagnosis of dementia, Parkinson’s disease, schizophrenia, or schizoaffective disorder, and any use of ECT during the previous 6 months. All study participants received the seizure-inducing ECT twice a week. The intensity of therapy varied per patient and session, with age and sex of a patient having been among the criteria used to determine the intensity of each stimulus administered. Treatments continued until a patient achieved remission or the patient’s benefits plateaued. The maximum number of sessions was 16.
Two assessors used the questions included in the HRSD17 to assess the decline in depression symptom severity for each patient every Wednesday between every second ECT session. A patient who achieved an HRSD17 score of 7 or less was considered to be in remission. The patient’s postictal reorientation time (PRT) following ECT therapy was recorded at the first and third treatments. “Assessments of the PRTs were timed relative to the assessments of depressive symptoms during the ECT course. Hence, the PRT at the third treatment was recorded 2 days after the second assessment of symptom severity,” wrote Tor Magne Bjølseth and colleagues. The PRT was defined as the minutes that passed until the patients were able to correctly answer four of five questions about themselves, their location, and the time. A maximum PRT score of 50 minutes was assigned to any patient who took more than 40 minutes to recover from disorientation.
While the researchers did not see a significant association between the mean PRT and the outcome of ECT, they observed that the patients with longer PRTs during early ECT sessions were likely to experience greater declines in depression symptoms.
The researchers also found that “a greater increment in [ECT] dosage rendered a smaller absolute and relative decline in PRT.”
An additional finding suggesting that ECT is beneficial for elderly patients with major depressive disorder was that the study participants’ HRSD17 scores on average declined by 14.7 points from baseline to the end of their ECT sessions.
“Our results indicate that a longer PRT reflects a more efficacious seizure and that the speed of recovery from disorientation may supplement [electroencephalogram] characteristics in tailoring stimulus dosing for elderly patients, at least early in the treatment course of formula-based ECT. It remains to be established whether our findings are generalizable beyond the elderly population and beyond formula-based methods. Further research is also warranted to clarify how the PRT may be utilized to guide stimulus dosing,” the researchers wrote.
Read the study in Journal of Affective Disorders ( doi: 10.1016/j.jad.2015.10.013 ).
