What do psychiatrists mean by medication resistance as an indication for electroconvulsive therapy?
OBJECTIVE
Resistance to antidepressant medication is the commonest stated indication for electroconvulsive therapy (ECT) by psychiatrists, but what this means in practice has not been described. Our aims were to survey what antidepressant drug treatment had been prescribed to patients before they underwent ECT and to what extent this treatment would satisfy operational criteria for adequate antidepressant drug treatment used in ECT research.


METHODS
The survey was conducted prospectively among 37 depressed patients referred for a new course of bilateral ECT and where antidepressant medication resistant was identified as the indication for ECT.


RESULTS
Only half the sample had been prescribed more than one antidepressant drug, and only 38% had been prescribed any augmentation compound. Although the majority of patients were resistant to medication when rated by the older operational criteria, only half the sample met contemporary criteria for medication resistance.


CONCLUSIONS
The findings suggest a lack of agreement between clinicians and researchers in what constitutes medication resistance as a possible indication for ECT. It will take some time to establish if the revised UK Royal College of Psychiatrists ECT Handbook will encourage more intensive medical treatment of depressive illness before the use of ECT.
Husain
Syed S
SS
Rowan House, Sandalwood Court, Swindon, United Kingdom. syed.husain@awp.nhs.uk
Kevan
Ian Mark
IM
Linnell
Rebecca
R
Scott
Allan I F
AI
D000928:Antidepressive Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003866:Depressive Disorder / Q000188:drug therapy* / Q000628:therapy*; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
D000928:Antidepressive Agents