title: Predictors of remission in 208 drug-resistant depressive patients treated with electroconvulsive therapy.
abstract: OBJECTIVE
  This study aimed to explore predictors of remission to electroconvulsive therapy (ECT) in a sample of depressive patients resistant to pharmacological treatments.
  
  
  METHODS
  Two hundred eight patients, 31 of whom had major depressive disorder, 101 had bipolar disorder II (BP II), and 76 had bipolar disorder I (BP I), diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were treated with bilateral ECT on a twice-a-week schedule. All patients included were undergoing a depressive episode, excluding patients with mixed and manic episodes. Patients were assessed before (baseline) and a week after the ECT course (final score) using the Hamilton Rating Scale for Depression-17 items (HAM-D-17), the Young Mania Rating Scale (YMRS), the Brief Psychiatric Rating Scale, and the Clinical Global Impression-Improvement (CGI-I).
  
  
  RESULTS
  At the end of the ECT course, 56 patients (26.9%) were considered nonresponders, and 80 patients (38.4%) were considered responders (HAM-D score of at least 50% and CGI-I subscale rating of 2, "much improved") and 72 remitters (34.6%) (HAM-D scores ≤8 and a CGI-I subscale rating of 1). On backward stepwise logistic regression length of current episode, Bipolar Disorder and baseline YMRS total mean scores were statistically significant predictors of nonresponders versus remitters. Among the YMRS items at basal evaluation 8 (thought content), 10 (appearance), and 11 (insight), the mean scores were significantly lower in the remitters than in the responders and nonresponders.
  
  
  CONCLUSIONS
  Major depressive disorder, short duration of the current episode, absence of psychotic symptoms, preserved insight, and adequate personal care are associated with complete remission in our sample of drug-resistant depressive patients treated with ECT.
authors.affiliation: From the *Department of Clinical and Experimental Medicine, University of Pisa, Italy; †Institute of Behavioral Science "G. De Lisio", Carrara-Pisa, Italy and ‡Intensive Care Unit 3, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Medda
authors.forename: Mauro
authors.initials: M
authors.lastname: Mauri
authors.forename: Cristina
authors.initials: C
authors.lastname: Toni
authors.forename: Michela Giorgi
authors.initials: MG
authors.lastname: Mariani
authors.forename: Salvatore
authors.initials: S
authors.lastname: Rizzato
authors.forename: Mario
authors.initials: M
authors.lastname: Miniati
authors.forename: Luigi
authors.initials: L
authors.lastname: De Simone
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004351:Drug Resistance; D004565:Electroconvulsive Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents