Patient-Reported Outcomes From a Randomized Controlled Trial Comparing Right Unilateral Electroconvulsive Therapy...

The objective was to compare acute and long-term patient-reported outcome measures (PROMs) of symptoms and functioning in treatment-resistant bipolar depression following right unilateral (RUL) electroconvulsive therapy (ECT) and algorithm-based pharmacological treatment (APT).

Inpatients with treatment-resistant bipolar depression were randomized to 6 weeks of RUL ECT or APT, followed by pharmacological maintenance treatment for 6 months. Three PROMS-the Medical Outcome Short-Form Health Assessment (RAND-36), the Everyday Memory Questionnaire (EMQ-28), and the Patient Global Impression of Improvement (PGI-I)-and the clinician-rated Montgomery and Åsberg Depression Rating Scale (MADRS) were applied pretreatment, posttreatment, and 6 months posttreatment. Group comparisons were performed using linear mixed-effects analysis.

Seventy-three patients (N_{RUL ECT} = 38, N_APT = 35) were randomized to treatment, of which 44 (N_{RUL ECT} = 23, N_APT = 21) completed acute treatment, and 39 (N_{RUL ECT} = 20, N_APT = 19) completed the 6-month follow-up. Immediately posttreatment, RUL ECT and APT patients showed improvements in seven and three of the eight RAND-36 dimensions, respectively, while improvements on the PGI-I were greater for RUL ECT than for APT patients (2.2 vs. 2.9, p = 0.010) as were those on the MADRS (13.1 vs. 18.1, p = 0.010), with no group difference on the EMQ-28. At 6 months, there were no significant group differences for any measure. EMQ-28 scores improved significantly from pretreatment to the 6-month follow-up only in the RUL ECT group (122.5 vs. 91.6, p < 0.001).

Two PROMs and the clinician-rated MADRS favored RUL ECT over APT after 6 weeks of treatment. These findings show the acute benefit of RUL ECT in the treatment of bipolar depression.