Melancholia as predictor of electroconvulsive therapy outcome in later life

Veltman, Eveline M.; de Boer, Alef; Dols, Annemiek; van Exel, Eric; Stek, Max L.; Sienaert, Pascal; Bouckaert, Filip; van der Mast, Roos; Rhebergen, Didi

doi:10.1097/YCT.0000000000000579

Title

Melancholia as predictor of electroconvulsive therapy outcome in later life

Author

Veltman, Eveline M.

de Boer, Alef

Dols, Annemiek

van Exel, Eric

Stek, Max L.

Sienaert, Pascal

Bouckaert, Filip

van der Mast, Roos

Rhebergen, Didi

Abstract

Objectives In clinical practice, particularly melancholic depression benefits from electroconvulsive therapy (ECT), albeit research melancholia criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) is not conclusive. We compared clinical characteristics and ECT outcome of melancholic and nonmelancholic depression, here defined by psychomotor symptoms. Methods One hundred ten depressed older in-patients treated with ECT were included in the Mood Disorders in Elderly treated with ECT study. The CORE was used for the assessment of psychomotor symptoms, with a score of 8 or higher defining melancholic depression. Depression severity was measured before, during, and after ECT. Characteristics were compared across melancholic and nonmelancholic patients. Regression analysis was used to assess the relation between psychomotor symptoms and remission/response, and survival analysis was used to examine the difference in time. Results Patients with melancholic depression had higher severity, lower cognitive and overall functioning, and lower prevalence of cardiovascular disease. However, no significant relations were found between CORE scores and remission/response. Because psychotic symptoms are a positive predictor of ECT response and remission, we examined whether CORE score was a predictor of response in the nonpsychotic group (n = 49). In nonpsychotic patients, remission was 62%, and the association between CORE scores and remission almost reached significance (P = 0.057). Discussion Although melancholically and nonmelancholically depressed patients differed significantly on several clinical characteristics, ECT outcome did not differ. Analyses may be hampered by a high prevalence of psychotic features. In nonpsychotic patients, CORE scores neared significance as predictor of remission, suggesting that CORE scores might be a distinguishing characteristic of melancholia in nonpsychotic patients and a clinical useful predictor of ECT response.

Language

English

Source (journal)

Journal of ECT. - Place of publication unknown

Publication

Place of publication unknown : 2019

ISSN

1095-0680

DOI

10.1097/YCT.0000000000000579

Volume/pages

35 :4 (2019) , p. 231-237