A naturalistic study of high-dose unilateral ECT among severely depressed inpatients: how does it work in the clinical practice?
BACKGROUND
Naturalistic studies can be useful tools to understand how an intervention works in the real clinical practice. This study aims to investigate the outcomes in a naturalistically treated depressed inpatients cohort, who were referred, or not, to unilateral ECT.


METHODS
Depressed adults according to MINI admitted in a psychiatric unit were divided in unilateral ECT treated and non-ECT treated. Main outcomes were: depression improvement in Hamilton Rating Scale for Depression (HDRS-17) scores; response (HDRS-17 improvement ≥50 %); remission (HDRS-17 score ≤7); length of hospitalization.


RESULTS
Forty-three patients were included in unilateral ECT group and 104 in non-ECT group. No differences of psychotic symptoms, melancholic features or past maniac episode were found between groups. Unilateral ECT group had a mean HDRS-17 score higher than non-ECT group at admission (ECT: 25.05 ± 1.03; non-ECT: 21.61 ± 0.69; p = 0.001), but no significant difference was found at discharge (ECT: 7.70 ± 0.81; non-ECT: 7.40 ± 0.51; p = 0.75). Unilateral ECT group had a larger HDRS-17 score reduction during treatment (ECT: 18.24 ± 1.18; non-ECT:14.20 ± 0.76; p = 0.004). There were no significant differences in response and remission rates between groups. Unilateral ECT group had longer mean duration of hospitalization in days (ECT: 35.48 ± 2.48; non-ECT: 24.57 ± 1.50; p < 0.001), but there were no difference in mean time of treatment (ECT group:27.66 ± 1.95; non-ECT: 24.57 ± 1.50; p = 0.25).


CONCLUSIONS
Unilateral high-dose ECT is still a useful treatment option, in the real world clinical practice, to reduce the intensity of depressive symptoms in highly depressed inpatients.
Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento - RS - Brazil, 2350, Ramiro Barcelos Street, Porto Alegre, Rio Grande do Sul, Brazil. lucaspcalves@gmail.com.
Lucas P C
LP
Alves
Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento - RS - Brazil, 2350, Ramiro Barcelos Street, Porto Alegre, Rio Grande do Sul, Brazil.
Thiago F V
TF
Freire
Universidade Federal do Rio Grande do Sul, Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Hospital de Clínicas de Porto Alegre-RS-Brazil, 2350, Ramiro Barcelos Street, Porto Alegre, Rio Grande do Sul, Brazil.
Marcelo P A
MP
Fleck
Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento - RS -Brazil, 2350, Ramiro Barcelos Street, Porto Alegre, Rio Grande do Sul, Brazil.
Neusa S
NS
Rocha
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000928:Antidepressive Agents
Depressive disorder; Electroconvulsive therapy; Naturalistic Study; Pragmatic Clinical Trials as Topic