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Updated: Feb 17, 2026
Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy
Published on: April 11, 2019
Little information, great impact? A clinical tool for the prediction of electroconvulsive therapy effectiveness in
Michael Belz1, Isabel Methfessel1, Matthias Besse1
1Department of Psychiatry and Psychotherapy, https://ror.org/021ft0n22University Medical Center Göttingen, D-Göttingen, Germany.
Background:
The effectiveness of electroconvulsive therapy (ECT) for depression strongly depends on patient characteristics. Clinical factors may increase (e.g. age, psychotic symptoms) or decrease (e.g. episode duration) response rates.
Aims:
This prospective study aimed to develop an instrument for the prediction of ECT response in patients with unipolar depression.
Method:
N = 45 patients were assessed using the Göttingen Response to ECT Assessment Tool (GREAT; seven items, 0 to 14 points). Clinical outcome was measured using the Montgomery Åsberg Depression Rating Scale (MADRS). Response was defined as ≥ 50% MADRS-improvement or a clinical global impression improvement (CGI-I) score ≤ 2. Analyses were conducted between responders and non-responders.
Results:
Results showed a high correlation between GREAT-score and dichotomous response (r = 0.585) as well as MADRS-improvement (r = 0.554, both p < 0.001). Receiver operating characteristic (ROC)-analysis yielded an area under the curve (AUC) of 0.841 (asymptotic significance: p < 0.001). A cut-off point at ≥7 points predicted ECT response in individual cases with 80% accuracy. GLM-analyses showed a significantly better MADRS-improvement for patients with a GREAT-score ≥ 7 v. < 7 (interaction-effect: p < 0.001).
Conclusions:
Our prospective study shows that an instrument consisting of seven clinical items is able to predict ECT response in depression with good accuracy. Limitations include a relatively small sample size and the lack of further potential predictors suggested by recent studies. GREAT will thus be modified to further improve its accuracy. Currently, it may give clinicians a relevant estimate of the likelihood and the extent of the individual response to ECT.
