A naturalistic study of high-dose unilateral ECT among severely depressed inpatients: how does it work in the clinical practice?

• Published in: BMC psychiatry Vol. 16; no. 1; p. 396
• Main Authors: Alves, Lucas P C, Freire, Thiago F V, Fleck, Marcelo P A, Rocha, Neusa S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11-11-2016; BioMed Central
• Subjects: Adult; Antidepressants; Antidepressive Agents - therapeutic use; Care and treatment; Clinical medicine; Clinical trials; Combined Modality Therapy; Depression, Mental; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - therapy; Dosage and administration; Drug dosages; Drug therapy; Electroconvulsive therapy; Electroconvulsive Therapy - methods; Electrodes; Female; Hospitalization; Humans; Inpatients; Length of Stay; Male; Mental depression; Middle Aged; Patients; Psychiatrists; Psychiatry; Psychosis; Response rates; Treatment Outcome; Brazil; Electroconvulsive therapy; Naturalistic Study; Pragmatic Clinical Trials as Topic; Depressive disorder
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-016-1095-z

Naturalistic studies can be useful tools to understand how an intervention works in the real clinical practice. This study aims to investigate the outcomes in a naturalistically treated depressed inpatients cohort, who were referred, or not, to unilateral ECT.
Depressed adults according to MINI admitted in a psychiatric unit were divided in unilateral ECT treated and non-ECT treated. Main outcomes were: depression improvement in Hamilton Rating Scale for Depression (HDRS-17) scores; response (HDRS-17 improvement ≥50 %); remission (HDRS-17 score ≤7); length of hospitalization.
Forty-three patients were included in unilateral ECT group and 104 in non-ECT group. No differences of psychotic symptoms, melancholic features or past maniac episode were found between groups. Unilateral ECT group had a mean HDRS-17 score higher than non-ECT group at admission (ECT: 25.05 ± 1.03; non-ECT: 21.61 ± 0.69; p = 0.001), but no significant difference was found at discharge (ECT: 7.70 ± 0.81; non-ECT: 7.40 ± 0.51; p = 0.75). Unilateral ECT group had a larger HDRS-17 score reduction during treatment (ECT: 18.24 ± 1.18; non-ECT:14.20 ± 0.76; p = 0.004). There were no significant differences in response and remission rates between groups. Unilateral ECT group had longer mean duration of hospitalization in days (ECT: 35.48 ± 2.48; non-ECT: 24.57 ± 1.50; p < 0.001), but there were no difference in mean time of treatment (ECT group:27.66 ± 1.95; non-ECT: 24.57 ± 1.50; p = 0.25).
Unilateral high-dose ECT is still a useful treatment option, in the real world clinical practice, to reduce the intensity of depressive symptoms in highly depressed inpatients.