Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression

Ahmed Al-Wandi¹, Mikael Landén^2,3, Axel Nordenskjöld¹

¹University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Acta Psychiatrica Scandinavica

|May 28, 2024

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View abstract on PubMed

Summary

Maintenance electroconvulsive therapy (M-ECT) did not significantly alter readmission or suicide rates in psychotic depression overall. However, for patients over 65, M-ECT showed a reduced risk for these adverse outcomes.

Area of Science:

Psychiatry
Clinical Neuroscience
Geriatric Medicine

Background:

Psychotic unipolar depression poses significant challenges in treatment and long-term management.
Electroconvulsive therapy (ECT) is an effective acute treatment, but the role of maintenance ECT (M-ECT) requires further investigation.
Understanding factors influencing readmission and suicide risk is crucial for improving patient outcomes.

Purpose of the Study:

To investigate the association between maintenance electroconvulsive therapy (M-ECT) and rates of psychiatric readmission and suicide in patients with psychotic unipolar depression.
To determine if this association is dependent on patient age.
To compare outcomes for patients receiving M-ECT versus those not receiving it after initial ECT.

Main Methods:

Utilized Swedish national registries (2008-2019) to identify patients with psychotic unipolar depression treated with ECT.
Compared outcomes between patients receiving M-ECT within 14 days of discharge and those who did not.
Employed Cox regression and within-individual analyses to assess the primary composite outcome (readmission, suicide attempt, or suicide) within two years.

Main Results:

A total of 1873 patients were analyzed; 130 received M-ECT.
No significant difference in the primary outcome was observed for the overall sample.
M-ECT was significantly associated with a decreased risk of the composite outcome in patients over 65 years old (aHR 0.55).
Within-individual analysis also favored M-ECT.

Conclusions:

M-ECT was not linked to a different risk of readmission or suicide in the general psychotic depression cohort.
For older adults (over 65), M-ECT demonstrated a significant association with reduced risk of readmission and suicide.
The potential for residual confounding factors in the observed associations cannot be ruled out.

Keywords:

electroconvulsive therapy maintenance psychotic depression readmission relapse

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