The efficacy of acute electroconvulsive therapy in atypical depression.
OBJECTIVE
This study examined the characteristics and outcomes of patients with major depressive disorder (MDD), with or without atypical features, who were treated with acute bilateral electroconvulsive therapy (ECT).


METHODS
Analyses were conducted with 489 patients who met DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the basis of the Structured Clinical Interview for DSM-IV obtained at baseline prior to ECT. Depression symptom severity was measured by the 24-item Hamilton Rating Scale for Depression (HAM-D(24)) and the 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR(30)). Remission was defined as at least a 60% decrease from baseline in HAM-D(24) score and a total score of 10 or below on the last 2 consecutive HAM-D(24) ratings. The randomized controlled trial was performed from 1997 to 2004.


RESULTS
The typical (N = 453) and atypical (N = 36) groups differed in several sociodemographic and clinical variables including gender (p = .0071), age (p = .0005), treatment resistance (p = .0014), and age at first illness onset (p < .0001) and onset of current episode (p = .0008). Following an acute course of bilateral ECT, a considerable portion of both the typical (67.1%) and the atypical (80.6%) groups reached remission. The atypical group was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group after adjustment for age, psychosis, gender, clinical site, and depression severity based on the HAM-D(24).


CONCLUSIONS
Acute ECT is an efficacious treatment for depressed patients with typical or atypical symptom features.


BACKGROUND
clinicaltrials.gov Identifier: NCT00000375.
Husain
Mustafa M
MM
Department of Psychiatry, University of Texas (UT) Southwestern Medical Center at Dallas, TX 75390-8898, USA. mustafa.husain@utsouthwestern.edu
McClintock
Shawn M
SM
Rush
A John
AJ
Knapp
Rebecca G
RG
Fink
Max
M
Rummans
Teresa A
TA
Rasmussen
Keith
K
Claassen
Cynthia
C
Petrides
Georgios
G
Biggs
Melanie M
MM
Mueller
Martina
M
Sampson
Shirlene
S
Bailine
Samuel H
SH
Lisanby
Sarah H
SH
Kellner
Charles H
CH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002391:Catchment Area, Health; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D016896:Treatment Outcome