title: Symptom predictors of response to electroconvulsive therapy in older patients with treatment-resistant depression.
abstract: BACKGROUND
  Electroconvulsive therapy (ECT) has been used for treatment-resistant depression. However, predictors of response to ECT have not been adequately studied using the Montgomery and Åsberg Depression Rating Scale, especially in older patients with treatment-resistant depression.
  
  
  METHODS
  This study included 18 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for a diagnosis of major depressive disorder or bipolar disorder with a current major depressive episode, and met the definition of treatment-resistant depression outlined by Thase and Rush, scoring ≥21 on the Montgomery and Åsberg Depression Rating Scale. The three-factor model of the Montgomery and Åsberg Depression Rating Scale was used for analysis. Factor 1 was defined by three items, factor 2 by four items, and factor 3 by three items, representing dysphoria, retardation, and vegetative symptoms, respectively. ECT was performed twice a week for a total of six sessions using a Thymatron System IV device with the brief pulse technique. Clinical responses were defined on the basis of a ≥50% decrease in total pretreatment Montgomery and Åsberg Depression Rating Scale scores.
  
  
  RESULTS
  The mean pretreatment factor 2 score for responders (n = 7) was significantly lower than that for nonresponders (n = 11). Furthermore, a significant difference in mean factor 3 score between responders and nonresponders was observed one week after six sessions of ECT, indicating a time lag of response. No significant differences were observed for age, number of previous episodes, and duration of the current episode between responders and nonresponders.
  
  
  CONCLUSIONS
  This study suggests that a low pretreatment factor 2 score is a good predictor of response to ECT in older patients with major depression.
authors.affiliation: Department of Neuropsychiatry, St Marianna University School of Medicine, Miyamae-ku, Kawasaki City, Kanagawa.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Tominaga
authors.forename: Mioto
authors.initials: M
authors.lastname: Okazaki
authors.forename: Hisashi
authors.initials: H
authors.lastname: Higuchi
authors.forename: Itaru
authors.initials: I
authors.lastname: Utagawa
authors.forename: Etsuko
authors.initials: E
authors.lastname: Nakamura
authors.forename: Noboru
authors.initials: N
authors.lastname: Yamaguchi