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

Area of Science:

• Psychiatry
• Neuroscience
• Clinical Medicine

Background:

• Treatment-resistant bipolar depression poses a significant clinical challenge.
• Electroconvulsive therapy (ECT) and algorithm-based pharmacological treatment (APT) are established treatment modalities.
• Comparing patient-reported outcomes (PROMs) and clinician ratings is crucial for evaluating treatment efficacy.

Purpose of the Study:

• To compare acute and long-term PROMs and clinician-rated outcomes in patients with treatment-resistant bipolar depression.
• To assess the efficacy of right unilateral (RUL) ECT versus APT over a 6-week treatment period and a subsequent 6-month follow-up.

Main Methods:

• Randomized controlled trial involving inpatients with treatment-resistant bipolar depression.
• Interventions included 6 weeks of RUL ECT or APT, followed by 6 months of maintenance pharmacotherapy.
• PROMs (RAND-36, EMQ-28, PGI-I) and clinician-rated MADRS were assessed at baseline, post-treatment, and 6-month follow-up.

Main Results:

• Immediately post-treatment, RUL ECT demonstrated superior improvements in RAND-36 dimensions and PGI-I compared to APT.
• Clinician-rated MADRS scores also showed greater improvement with RUL ECT post-treatment.
• At 6 months, no significant group differences were observed, although RUL ECT showed sustained improvement in EMQ-28 scores.

Conclusions:

• RUL ECT provided acute benefits over APT in treating treatment-resistant bipolar depression, supported by both patient and clinician measures.
• These findings highlight the acute efficacy of RUL ECT for this patient population.
• Long-term functional outcomes did not differ significantly between the two treatment groups at 6 months.