Older patients with late-onset treatment-resistant depression and psychotic symptoms appear to get better results from electroconvulsive therapy than those with early-onset depression and fewer psychotic symptoms, a longitudinal study of 110 patients suggests.

“Our results indicate that [electroconvulsive therapy] is very effective even in pharmacotherapy-resistant [late-life depression] with vascular burden,” wrote Annemiek Dols, MD, PhD, Filip Bouckaert, MD, and associates.

The investigators recruited severely depressed patients who were receiving electroconvulsive therapy (ECT) from psychiatric hospitals in Amsterdam and Leuven, Belgium, as part of the Mood Disorders in Elderly Treated with Electroconvulsive Therapy (MODECT) study between January 2011 and December 2013.

They defined early-onset depression as a first depressive episode experienced by patients before age 55 years. Late-onset depression was defined as a first depressive episode that occurred at age 55 and older, reported Dr. Dols of the department of old age psychiatry at GGZ inGeest in Amsterdam and Dr. Bouckaert of the department of radiology and nuclear medicine at VU University Medical Center , also in Amsterdam.

The average age of the 110 patients was 73 years, and 72 were women. Patients with diagnoses of bipolar and schizoaffective disorder were excluded, as were patients with a history of neurologic illnesses such as Parkinson’s disease, stroke, or dementia.

Dr. Dols, Dr. Bouckaert, and associates measured the patients’ cognition using several instruments, including the 30-point Mini-Mental State Examination ( MMSE ) before, during, and after 1 week of a course of ECT. A response was defined as an improvement of 50% or more in Montgomery-Åsberg Depression Rating Scale ( MADRS ) scores from baseline during an ECT course. Remission was defined as a MADRS score below 10 points after ECT ( Am J Geriatr Psychiatry. 2017 Feb;25[2]:178-89 ).

Mean MMSE scores climbed from 24.5 before ECT to 27.25 for the early-onset depression patients, compared with 24.04 to 25.39 for the late-onset depression patients. Overall, the investigators reported, patients with late-onset depression had a response rate of 86.9%, compared with a response rate of 67.3% for those with early-onset depression after receiving a similar number of ECT sessions.

However, the higher response rates in late-onset depression could not be explained by “clinical or structural brain characteristics,” the investigators noted. “The number of responders with [late-onset depression] was probably too low (n = 8) to find statistically significant associations.”

To read more about the study, click here .

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