A team of Dutch researchers, led by UMC Utrecht, has developed a prediction model that could help psychiatrists determine when the use of electroconvulsive therapy (ECT) for people with depression is justified. Their findings have been published in the scientific journal Molecular Psychiatry.
Depression is one of the most common mental disorders worldwide. In the Netherlands, it is estimated that one in five adults will experience depression at some point in their lives. For 10% to 20% of these individuals, depression becomes chronic, meaning that the symptoms persist for a long period of time. In specialized treatment centers, more than 30% of patients experience a chronic course of depression. Many of these patients are eventually considered treatment-resistant, which means they do not respond to multiple attempts with medications or therapies.
Electroconvulsive therapy (ECT) is an effective treatment for people who do not respond to medication or psychotherapy. Unfortunately, predicting in advance who will benefit from ECT and when the therapy is best applied remains a challenge. “This is an issue, as ECT can have side effects such as memory loss,” says Annemiek Dols, researcher and psychiatrist at UMC Utrecht. “We therefore want to move towards a situation where we can apply ECT at the right time and in the right patients.”
To achieve this, Dols and her colleagues from the Dutch ECT Consortium have been working on a new model in recent years to predict the outcomes of ECT treatment. The researchers collected and analyzed data from nearly 1,900 patients with severe depression across 22 clinical and research cohorts in the Netherlands. Their goal: to map out the factors that predict a positive response to ECT.
Initial analyses by the consortium show that certain factors are associated with a greater likelihood of improvement after ECT. For example, older patients and those who have experienced their current depression for a shorter period of time respond better to treatment. Additionally, patients with psychotic features or those who have not yet tried many different antidepressants have a greater chance of successful treatment. “For this group, we could consider ECT earlier in the treatment process,” Annemiek explains.
The model needs to be refined further: the factors studied by the consortium can currently only predict 19% of whether the ECT treatment will be successful. “There are still many factors that we do not have a good understanding of, such as biological and social influences. Our work is far from finished,” Annemiek says. “We are now planning follow-up research into these types of social and biological factors. In doing so, we want to better understand how psychiatrists currently estimate whether ECT will work or not. In essence, we aim to capture their intuition in our model.”
Bit by bit, the researchers hope to optimize the prediction model so that it can ultimately predict with good reliability whether ECT is a logical step in the treatment of people with depression, and when psychiatrists should best use the therapy. Annemiek: “Ultimately, it’s all about helping our patients in the best way possible. Sometimes that means ECT, and sometimes it doesn’t.”
