Depression severity self-assessment to guide relapse potential stratification during maintenance ECT

The severity of major depressive disorder (MDD) is crucial in guiding treatment decisions for electroconvulsive therapy (ECT), particularly given the high relapse rates post-ECT. Maintenance-ECT (M-ECT) has emerged as a key strategy to prevent relapse, with recent trends favouring symptom-driven approaches. This study explores the use of self-report scales as an adjunct to clinician-rated assessments in M-ECT decision-making, focusing on the Clinician-Rated 30-item Inventory of Depressive Symptomatology (IDS-C) and its self-report version (IDS-SR). In the Preventing Relapse After Successful ECT for Depression (PRASED) study, a subsample of 96 MDD patients were included upon achieving remission after an acute ECT course. Patients were stratified into relapse potential categories based on weekly IDS-C scores, determining the need for zero, one, or two M-ECT sessions the following week. Using five monthly IDS-C and -SR, the scales demonstrated good to excellent agreement, with intraclass correlation coefficients ranging from 0.73 to 0.85 at multiple timepoints during M-ECT. Notably, 81 % of decision-making outcomes were concordant. Also, 16 % would result in patients receiving more ECT sessions based on the IDS-SR than the IDS-C, highlighting some overestimation by self-report scores. These findings indicate that self-assessment of depression severity by IDS-SR is a reliable alternative for clinician-rated measurements during M-ECT. Hence, this reduction of resource burden by self-report could facilitate the widespread implementation of personalised M-ECT, which may improve patient outcomes by reducing relapse rates in MDD. Future research should focus on validating self-report measures as reliable alternatives to clinician assessments in M-ECT to optimize treatment personalization and efficiency.