title: EFFICACY AND LONG-TERM CLINICAL OUTCOME OF COMORBID POSTTRAUMATIC STRESS DISORDER AND MAJOR DEPRESSIVE DISORDER AFTER ELECTROCONVULSIVE THERAPY.
abstract: Many patients fulfill criteria for both posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Electroconvulsive therapy (ECT) is generally acknowledged to be the most-effective treatment for refractory MDD. This study investigated the efficacy of ECT on long-term clinical outcome of comorbid PTSD and MDD.
  
  
  
  This retrospective nested matched case-control study is inclusive of 22,164 subjects [3,485 with comorbid MDD and PTSD (92 with ECT and 3,393 without ECT) and 18,679 without MDD and PTSD].
  
  
  
  Using the clinical global impression scale (CGI) to assess efficacy, more-robust improvement of PTSD and MDD symptoms was observed with ECT (90%), compared to antidepressant-treatment alone(50%) (P = 0.001). During the median of 8 years of follow-up, the death-rate was 8% in subjects without PTSD and MDD, 9.7% in PTSD and MDD treated with ECT and 18% in PTSD and MDD without ECT (P < 0.05). The suicide-rate was 2.2 and 5.9% in PTSD and MDD with and without ECT-treatment, respectively (P < 0.05). Survival-analyses revealed that the relative-risk of cardiovascular and all-cause mortality is not significantly different in patients with comorbid MDD and PTSD treated with ECT, compared to a matched-cohort without PTSD and MDD (P > 0.05). The relative risk of suicidality, all-cause, and cardiovascular mortality was reduced 64, 65, and 46% in MDD and PTSD patients treated with ECT, compared to those without ECT (P < 0.05).
  
  
  
  ECT is associated with a significant reduction of symptoms of PTSD and MDD, as well as reduction in risk of suicidality, cardiovascular, and all-cause mortality in MDD and PTSD, an effect more robust than antidepressant-therapy alone.
authors.affiliation: Captain James A Lovell Federal Healthcare Center, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.|David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Naser
authors.initials: N
authors.lastname: Ahmadi
authors.affiliation: Captain James A Lovell Federal Healthcare Center, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
authors.forename: Lori
authors.initials: L
authors.lastname: Moss
authors.affiliation: Captain James A Lovell Federal Healthcare Center, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
authors.forename: Edwin
authors.initials: E
authors.lastname: Simon
authors.affiliation: Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Nemeroff
authors.affiliation: Captain James A Lovell Federal Healthcare Center, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
authors.forename: Nutan
authors.initials: N
authors.lastname: Atre-Vaidya
mesh_terms: D016022:Case-Control Studies; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy*; D013405:Suicide / Q000706:statistics & numerical data; D013995:Time; D016896:Treatment Outcome
keywords: electroconvulsive therapy; major depressive disorder; mortality; outcome; posttraumatic stress disorder; suicide