Electroconvulsive therapy in depressive illness that has not responded to drug treatment.
BACKGROUND
Antidepressant medication resistance is the commonest indication for electroconvulsive therapy (ECT) in Scotland. Evidence from the USA suggests that clinical response is reduced for medication resistant patients. The aim of the present study was to establish if the American results were generalisable to routine clinical practice in Edinburgh.


METHODS
Fifty eligible depressed patients consecutively referred for a new course of bilateral ECT at the Royal Edinburgh Hospital were prospectively assessed as part of the National Audit of ECT in Scotland. The patients were categorised into those who had received adequate drug treatment pre-ECT (and could therefore be classed as medication resistant) and those who had not, using five operational definitions. The clinical response of the ECT was then compared between groups, using the Montgomery-Asberg Rating Scale for Depression (MADRS) and Clinical Global Impression Scale (CGI).


RESULTS
Patients defined as medication resistant had an identical response to patients who were not defined as medication resistant (in both groups 60% met the predetermined criterion for clinical response), and this was consistent across the five operational definitions.


CONCLUSIONS
The hypothesis that medication resistance is associated with a reduced probability of clinical response to ECT was not supported.


CONCLUSIONS
Some patients who were inadequately drug treated might have proven eventually to be medication resistant, which would have obscured a potential difference in clinical response. It is not known how generalisable the results are to clinical practice in the rest of the UK.
Husain
Syed S
SS
Rowan House, Sandalwood Court, Highworth Road, Swindon, SN3 4WF, United Kingdom. syed.husain@awp.nhs.uk
Kevan
Ian Mark
IM
Linnell
Rebecca
R
Scott
Allan I F
AI
D000328:Adult; D000341:Affective Disorders, Psychotic / Q000175:diagnosis / Q000628:therapy*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012606:Scotland; D055502:Secondary Prevention; D017211:Treatment Failure; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents