Which residual symptoms predict relapse after successful electroconvulsive therapy for late-life depression?

Introduction Introduction: Residual depressive symptoms are common after a successful acute treatment of late-life depression (LLD), and their presence predicts increased risk of relapse. While electroconvulsive therapy (ECT) is the most effective treatment for LLD, little is known about which particular symptoms remain and impact long-term outcome after a successful acute ECT course. Objectives Objectives: We aimed to assess the association between specific residual depressive symptoms after an effective acute ECT course for LLD and relapse at six-month follow-up. Methods Methods: In this prospective cohort study, including 110 patients aged 55 years and older with LLD, information about relapse was collected six months after the acute ECT course. Relapse was defined as a Montgomery-Åsberg Depression Rating Scale (MADRS) score >15, hospital admission or restart of ECT. We used multivariable stepwise logistic regression models including the scores on the 10 individual MADRS items at the end of the acute ECT course to predict relapse. Results Results: Of the 80 responders with available six-month follow-up data, 29 patients (36.25%) had suffered relapse. Higher scores on the MADRS items ‘reduced sleep’ (odds ratio (OR)=2.03, 95% confidence interval (CI)=1.11-3.69, p=0.0214) and ‘lassitude’ (OR=1.62, 95% CI=1.00-2.62, p=0.0497) at the end of the acute ECT course were significantly associated with increased risk of relapse at six-month follow-up. Conclusions Conclusions: Some residual depressive symptoms, including sleep disturbance and fatigue, may help better identify patients vulnerable to relapse following a successful acute ECT course for LLD. Future studies assessing interventions that target specific residual symptoms may further reduce post-ECT depressive relapse. Disclosure No significant relationships.

[1]  S. Grimm,et al.  EffECTively Treating Depression: A Pilot Study Examining Manualized Group CBT as Follow-Up Treatment After ECT , 2021, Frontiers in Psychology.

[2]  C. Kellner.  Electroconvulsive Therapy: Stayin’ Alive, Stayin’ Well , 2021, Acta psychiatrica Scandinavica.

[3]  G. Bonanno,et al.  Networks of major depressive disorder: A systematic review. , 2021, Clinical psychology review.

[4]  P. Sienaert,et al.  Does lithium prevent relapse following successful electroconvulsive therapy for major depression? A systematic review and meta‐analysis , 2021, Acta psychiatrica Scandinavica.

[5]  E. V. van Someren.  Brain mechanisms of insomnia: new perspectives on causes and consequences. , 2020, Physiological reviews.

[6]  P. Sienaert,et al.  Psychotic late-life depression less likely to relapse after electroconvulsive therapy. , 2020, Journal of affective disorders.

[7]  Sona Dimidjian,et al.  Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive Symptoms: A Randomized Clinical Trial. , 2020, JAMA psychiatry.

[8]  Rachel Manber,et al.  Cognitive Behavioral Therapy for Insomnia in Depression. , 2019, Sleep medicine clinics.

[9]  C. Nemeroff,et al.  Benefits of Sequentially Adding Cognitive-Behavioral Therapy or Antidepressant Medication for Adults With Nonremitting Depression. , 2019, The American journal of psychiatry.

[10]  B. Penninx,et al.  Severity, course trajectory, and within‐person variability of individual symptoms in patients with major depressive disorder , 2018, Acta psychiatrica Scandinavica.

[11]  S. Hollon,et al.  Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis , 2018, Clinical psychology review.

[12]  Joan Prudic,et al.  Electroconvulsive therapy in the continuation and maintenance treatment of depression: Systematic review and meta-analyses , 2018, The Australian and New Zealand journal of psychiatry.

[13]  K. Wardenaar,et al.  Seeing the signs: Using the course of residual depressive symptomatology to predict patterns of relapse and recurrence of major depressive disorder , 2018, Depression and anxiety.

[14]  T. Paunio,et al.  European guideline for the diagnosis and treatment of insomnia , 2017, Journal of sleep research.

[15]  Charles F. Reynolds,et al.  Management of Depression in Older Adults: A Review , 2017, JAMA.

[16]  M. Mimura,et al.  Predicting relapse with individual residual symptoms in major depressive disorder: a reanalysis of the STAR*D data , 2017, Psychopharmacology.

[17]  F. Barkhof,et al.  Early- and Late-Onset Depression in Late Life: A Prospective Study on Clinical and Structural Brain Characteristics and Response to Electroconvulsive Therapy. , 2017, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[18]  Eiko I. Fried,et al.  The 52 symptoms of major depression: Lack of content overlap among seven common depression scales. , 2017, Journal of affective disorders.

[19]  M. Husain,et al.  Right Unilateral Ultrabrief Pulse ECT in Geriatric Depression: Phase 1 of the PRIDE Study. , 2016, The American journal of psychiatry.

[20]  B. Mulsant,et al.  Systematic Review of Cognitive Effects of Electroconvulsive Therapy in Late-Life Depression. , 2016, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[21]  Z. Segal,et al.  Mindfulness-based cognitive therapy for residual depressive symptoms and relapse prophylaxis , 2016, Current opinion in psychiatry.

[22]  Eiko I. Fried,et al.  Depression sum-scores don’t add up: why analyzing specific depression symptoms is essential , 2015, BMC Medicine.

[23]  Eiko I. Fried,et al.  Problematic assumptions have slowed down depression research: why symptoms, not syndromes are the way forward , 2015, Front. Psychol..

[24]  R. Shelton,et al.  Reliability and validity of the Symptoms of Depression Questionnaire (SDQ) , 2014, CNS Spectrums.

[25]  Eiko I. Fried,et al.  The Impact of Individual Depressive Symptoms on Impairment of Psychosocial Functioning , 2014, PloS one.

[26]  D. McLoughlin,et al.  Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis , 2013, Neuropsychopharmacology.

[27]  Daniel J. Taylor,et al.  Which depressive symptoms remain after response to cognitive therapy of depression and predict relapse and recurrence? , 2010, Journal of affective disorders.

[28]  M. Fava,et al.  Type of residual symptom and risk of relapse during the continuation/maintenance phase treatment of major depressive disorder with the selective serotonin reuptake inhibitor fluoxetine , 2010, European Archives of Psychiatry and Clinical Neuroscience.

[29]  Patrick E. McKnight,et al.  The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research. , 2009, Clinical psychology review.

[30]  Daniel J Buysse,et al.  Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy? , 2008, Depression and anxiety.

[31]  Daniel J. Buysse,et al.  Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications , 2008, Dialogues in clinical neuroscience.

[32]  E. Paykel.  Partial remission, residual symptoms, and relapse in depression , 2008, Dialogues in clinical neuroscience.

[33]  B. Mulsant,et al.  Residual symptoms and recurrence during maintenance treatment of late-life depression. , 2007, Journal of affective disorders.

[34]  M. Biggs,et al.  Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). , 2006, Archives of general psychiatry.

[35]  Daniel J Buysse,et al.  Psychological and behavioral treatment of insomnia:update of the recent evidence (1998-2004). , 2006, Sleep.

[36]  D. Steffens,et al.  Residual symptoms in older patients treated for major depression , 2005, International journal of geriatric psychiatry.

[37]  H. Möller,et al.  Improving the chance of recovery from the short‐ and long‐term consequences of depression , 2003, International clinical psychopharmacology.

[38]  M. Thase,et al.  Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. , 2001, JAMA.

[39]  S H Lisanby,et al.  A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. , 2000, Archives of general psychiatry.

[40]  A. Beekman,et al.  Review of community prevalence of depression in later life , 1999, British Journal of Psychiatry.

[41]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[42]  D. Borsboom,et al.  What are 'good' depression symptoms? Comparing the centrality of DSM and non-DSM symptoms of depression in a network analysis. , 2016, Journal of affective disorders.

[43]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.