title: Differential response to right unilateral ECT in depressed patients: impact of comorbidity and severity of illness [ISRCTN39974945].
abstract: BACKGROUND
  Recent electroconvulsive therapy (ECT) efficacy studies of right unilateral (RUL) ECT may not apply to real life clinics with a wide range of patients with major depressive episodes.
  
  
  METHODS
  The study included two groups of patients. In addition to a homogeneous group of patients with major depression according to DSM-IV criteria with severity of the major depressive episode > 16 scores on 17-item Hamilton Rating Scale for Depression (HDRS) (Group 1, n = 16), we included a heterogeneous group of patients with less severe major depressive episodes or with a variety of comorbid conditions (Group 2, n = 24). We randomly assigned the patients to an RUL ECT treatment dosed at 5 or 2.5 times seizure threshold with an intent-to-treat design. The outcomes measured blindly were HDRS, number of treatments, and Mini-Mental State Examination (MMSE). The patients were considered to have responded to treatment if the improvement in HDRS score was at least 60% and they had a total score of less than ten.
  
  
  RESULTS
  The Group 2 patients responded poorer (8% vs. 63%), and had more often simultaneous worsening in their MMSE scores than Group 1 patients. The differences in the outcomes between the two different doses of RUL ECT treatment were not statistically significant.
  
  
  CONCLUSIONS
  ECT effectiveness seems to be lower in real-life heterogeneous patient groups than in homogeneous patient samples used in experimental efficacy trials.
authors.affiliation: Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland. pertti.heikman@hus.fi
authors.forename: Pertti
authors.initials: P
authors.lastname: Heikman
authors.forename: Heikki
authors.initials: H
authors.lastname: Katila
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.forename: Kristian
authors.initials: K
authors.lastname: Wahlbeck
authors.forename: Kimmo
authors.initials: K
authors.lastname: Kuoppasalmi
mesh_terms: D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D005387:Finland / Q000453:epidemiology; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome