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Effects of electroconvulsive therapy for depression on health related quality of life. Adam Kavanagh. Acknowledgements. Prof. Declan McLoughlin Dr. Maria Semkovska , Dr. Ross Dunne, Dr. Martha Noone , Dr. Erik Kolshus , Ana Jelovac , Sinead Lambe , Mary Carton - PowerPoint PPT Presentation
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Acknowledgements
• Prof. Declan McLoughlin
• Dr. Maria Semkovska, Dr. Ross Dunne, Dr. Martha Noone, Dr. Erik Kolshus, Ana Jelovac, Sinead Lambe, Mary Carton
• Shane McCarron, Ger Ryan, Lucy Kiely
Depression
• 7% - 12% for men
• 20% - 25% for women• 4th highest contributor to total burden of disease
• 2nd leading cause of disability by 2020
Low mood or Anhedonia
WeightSleepConcentrationPsychomotor agitation/ retardationFatigueWorthlessness/ guiltSuicidal thoughts
The symptoms cause clinically significant impairment in functioning
Aim
• The aim of this study was to compare the
effects of 1.5 × ST bitemporal and high dose (6
× ST) RUL ECT administered twice weekly on
Health related quality of life (HRQOL)
Methodology
• EFFECT-DEP TRIAL (ISRCTN23577151)
– Design
– Location
– Inclusion/ Exclusion
– Randomization
– Primary outcome
– Power
SF-36• A generic outcome measure • Subjectively rated• Only 36 questions• 8-scale profile of functional health and well-being• Psychometrically-based physical and mental health
summary measures• Normative data • Sensitive to change • Most frequently used patient rated outcome
measure used in clinical trials (Scoggins & Patrick 2009)
Results
High-dose RUL
Mean (SD)
Bitemporal
Mean (SD)
t-test (d.f.) χ²-test (d.f.) P
Demographic
details
Age 56.7 (15.0) 59.1 (13.8) -1.173 (98) P = 0.244
Female 29 (58%) 31 (62%) 0.167 (1) P = 0.683
Clinical details
Baseline HDRS 30.3 (6.8) 29.3 (7.0) 0.720 (98) P = 0.473
Baseline BDI II 32.1 (11.9) 37.2 (13.6) -1.515 (56) P = 0.135
Psychotic 8 (16%) 6 (12%) 0.500 (1) P = 0.479
Treatment
resistant
25 (50%) 30 (60%) 0.646 (1) P = 0.421
Previous ECT 22 (44%) 20 (40%) 0.041 (1) P = 0.839
Pre-treatment N (RUL = 36, Bi = 32), 6 months N (RUL = 26, bi = 28),
Completed both assessments (RUL = 21, Bi = 22)
Pre-treatment N (RUL = 36, Bi = 32), 6 months N (RUL = 26, bi = 28),
Completed both assessments (RUL = 21, Bi = 22)
Linear model
MCS score =
Treatment parameters (Laterality, dose, seizure duration)
+ Patient characteristics (Gender, age)
+ Clinical details (Medications, resistance, remission status,
cognitive functioning)
Remission status at EOT
Summary
• Depression significantly impacts HRQOL• ECT is associated with improvements in
subjectively assessed HRQOL• High dose RUL ECT is as effective as standard
bitemporal ECT• Persistent deficits 6 months after treatment• Remission status at EOT explained persistent
deficits
Strengths & limitations
• Strengths– Randomized design– Large sample size– New information about HDRUL ECT– Generalizable results– No difference between participants that completed
assessments and those that did not– Robust outcomes measure– Robust data analysis approach
• Limitations– Loss of data at 6 months
Health related quality of life
• HRQOL – depression• HRQOL – depression and ECT• HRQOL – depression and ECT and NICE ‘03 + ‘09
N
Dep
ress
ion
seve
rity
scal
e
Ran
dom
al
loca
tion
Blin
ding
Sham
co
mpa
riso
n gr
oup
R
emiss
ion
crite
ria
Med
icat
ion
use d
urin
g tr
ial
Wav
e for
m
Trea
tmen
t te
rmin
ated
by
Freq
uenc
y of
tr
eatm
ent
Late
ralit
y
Freeman et al (1978)
40
HDRS Double
blind
Partial course
Regular medications maintained during trial
Sine wave
Treating clinical
team
Twice weekly
Bilateral
Lambourn & Gill (1978)
32
HDRS Double
blind Benzodiazepines only
Brief pulse
Treating clinical
team
Thrice weekly
Right Unilateral
Johnstone et al (1980)
70
HDRS Double
blind Benzodiazepines only
Sine Wave
Treating clinical
team
Twice weekly
Bifrontal
West (1981) 22
Visual analogue
scale
Double blind 50mg
amitriptyline at night
Sine wave
Treating clinical
team
Twice weekly
Bilateral
Brandon et al (1984)
77
HDRS &
MADRS
Double blind Benzodiazepines
only Sine wave
Treating clinical
team
Twice weekly
Bilateral
Gregory et al (1985)
69
MADRS &
HDRS
Double blind Benzodiazepines
only Sine wave
Treating clinical
team
Twice weekly
Bilateral and right unilateral
groups
Electroconvulsive therapy
• The UK ECT Review Group (2003) - meta-analysis: – Real ECT more effective than simulated ECT: – 9·7 point difference in HDRS
• Janicak et al (1985) – Meta-analysis:– MAOI – ECT more effective by 45%– Tricyclic – ECT more effective by 20%
• SSRI – ECT significantly more effective than Paroxetine (Folkerts et al. 1997): – 59% Vs reduction 29% reduction in HDRS score.