The Efficacy of Acute ECT in Atypical Depression
Husain MM, McClintock SM, Rush AJ, Knapp RG, Fink M, Rummans TA, Rasmussen K, Claassen C,
Petrides G, Biggs MM, Mueller M, Sampson S, Bailine SH, Lisanby SH, Kellner CH.
From the Department of Psychiatry, University of Texas (UT) Southwestern Medical Center at Dallas (Drs. Husain, McClintock, Rush, Claassen, and Biggs); Brain Stimulation and Therapeutic Modulation Division, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York (Drs. McClintock and Lisanby); Departments of Psychiatry and Behavioral Sciences, and Biostatistics, Bioinformatics, and Epidemiology, College of Medicine (Dr. Knapp), and Department of Biostatistics (Dr. Mueller), Medical University of South Carolina (MUSC), Charleston; Department of Psychiatry, Hillside Hospital/Long Island Jewish Health System, New York, N.Y. (Drs. Fink and Bailine); Department of Psychiatry, Mayo Clinic, Rochester, Minn. (Drs. Rummans, Rasmussen, and Sampson); and Department of Psychiatry, University of Medicine and Dentistry of New Jersey (UMDNJ), Newark (Drs. Petrides and Kellner).
J Clin Psychiatry. 2008 Feb 13;:e1-e6


OBJECTIVE: This study examined the characteristics and outcomes of patients with major depressive disorder (MDD), with or without atypical features, who were treated with acute bilateral electroconvulsive therapy (ECT). METHOD: Analyses were conducted with 489 patients who met DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the basis of the Structured Clinical Interview for DSM-IV obtained at baseline prior to ECT. Depression symptom severity was measured by the 24-item Hamilton Rating Scale for Depression (HAM-D(24)) and the 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR(30)). Remission was defined as at least a 60% decrease score and a total from baseline in HAM-D(24) score of 10 or below on the last 2 consecutive HAM-D(24) ratings. The randomized controlled trial was performed from 1997 to 2004. RESULTS: The typical (N = 453) and atypical (N = 36) groups differed in several sociodemo-graphic and clinical variables including gender (p = .0071), age (p = .0005), treatment resistance (p = .0014), and age at first illness onset (p < .0001) and onset of current episode (p = .0008). Following an acute course of bilateral ECT, a considerable portion of both the typical (67.1%) and the atypical (80.6%) groups reached remission. The atypical group was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group after adjustment for age, psychosis, gender, clinical site, and depression severity based on the HAM-D(24). CONCLUSION: Acute ECT is an efficacious treatment for depressed patients with typical or atypical symptom features. TRIAL REGISTRATION: Identifier: NCT00000375.
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