| BackgroundPatients with depressive disorder are mainly characterized by persistent low mood,accompanied by cognitive and behavioral changes.Some patients may have psychopathic symptoms of varying degrees,and in severe cases,self-injury and suicide may occur.The huge population of patients with depression has brought heavy burden to the society.Most of the patients with depression can achieve clinical remission or even recovery after professional antidepressant treatment,but there are also a considerable number of patients are not sensitive to antidepressant treatment,which is called treatment resistant depression(TRD).A growing number of studies have found that changes in cognitive function in patients with treatment resistant depression are universal,run through the disease,and are independent symptom areas that cannot be completely recovered with treatment.Many scholars have tried to predict the efficacy of antidepressant therapy by means of patients’ baseline cognitive function.Research on electroconvulsive therapy(ECT),as the most effective antidepressant therapy,has been relatively inadequate.In addition,some researchers have used the early improvement of antidepressant treatment to predict the outcome of treatment,but the conclusions are not consistent and deserve further discussion.Part TwoEfficacy and safety of electroconvulsive therapy for treatment resistant depressionMethodsThe enrolled TRD patients were treated with 8 standard ECT courses.Demographic data and Case characteristics were recorded using Case Report Form(CRF).Hamilton Depression Scale-17 items(HAMD-17)and Hamilton Anxiety Scale-14 items(HAMA-14)were used to evaluate patients at baseline and after the second,fourth,sixth,and eighth sessions of ECT.Baseline status and completion of the entire course of treatment were assessed using the Beck Suicidal Ideation Scale,PartⅠ(SSI-I).To analyze the differences in sociodemographic and clinical characteristics between treatment outcome groups,Pearson x 2 test or Fisher’ s exact test was used for categorical variables.Shapiro-Wilk normality test is performed on the continuous variables.If variables obey normal distribution,independent sample t test was used to identify the factors that influence efficacy,otherwise,Mann-Whitney U test was performed.A linear mixed model was used to analyze whether there were differences in the scale scores over time among the different treatment outcome groups.ResultsIn total,40(83.3%)of the 48 patients achieved a response after completing ECT,and 31(64.6%)achieved a response.There were no significant differences in demographic and clinical characteristics between responders and non-responders,while there was a significant difference in baseline SSI-I scores between responders and non-responders(P=0.02),and the responders were more likely to have a lower baseline SSI-I score.The temporal main effect of HAMD-17 score was significant(F=33.5,P<0.001)in both responders and non-responders,which decreased significantly after completion of treatment.However,HAMD-17 score decreased in the responders at the early and late stages of treatment,while HAMD-17 score did not significantly decrease in the non-responders at the late stage of treatment.The scores of HAMA-14 and SSI-I were significantly decreased in both the response group and the non-response group.This study has a total of 65 patients accepted ECT TRD,finally caused by side effects and treatment group in 5 cases(7.7%),the other 60 patients(92.3%)in the treatment process does not appear serious side effects.Mild reactions appeared in some patients such as dizziness,headache,muscle aches,nausea and so on,remitted after proper rest.Conclusions(1)ECT is effective,effective and safe for patients with TRD;(2)TRD patients with low suicidal ideation were more likely to achieve remission after ECT.Part ThreeEarly clinical improvement of electroconvulsive therapy in refractory depression predicts the outcome of treatment resistant depressionMethodsThe independent sample t-test was used to compare the reduction rate of HAMD-17 after the second and fourth ECT between groups with different therapeutic outcomes,and the one with significant difference was used to predict the treatment outcome of the patients.The prediction effect is evaluated by the area under the ROC(receiver operating characteristic)curve(AUC).Sensitivity and specificity were used to calculate the Youden Index and the corresponding HAMD-17 reduction rate as the cut-off point,which were divided into two subgroups with and without early improvement.Kaplan-Meier survival analysis was used to compare the onset time of treatment in the two subgroups.The survival analysis was evaluated by log-rank test.ResultsThe reduction rate of HAMD-17 after the fourth ECT was significantly different between responders and non-responders(P=0.002),and between remissions and non-remissions(P=0.002).The HAMD-17 reduction rate after the fourth ECT had the highest AUC of 79.8%in predicting treatment response.Using sensitivity and specificity,the maximum Youden index was 0.500,and the corresponding reduction rate of HAMD-17 was 34.8%,sensitivity was 87.5%,and specificity was 62.5%.The patients were divided into two subgroups:those with early improvement(19 cases)and those without early improvement(29 cases).Survival analysis found that the mean time to response in the group with early improvement was 6.1 days(95%CI:4.8-7.4),and the mean time to response in the group without early improvement was 11.8 days(95%CI:7.7-15.9),log-rank test P=0.001(x 2=12.0,df=1),that is,there was a significant difference in response time between the two groups.Mixed linear model analysis showed that the HAMD-17 scores of both groups were significantly decreased after treatment.Compared with the group with early improvement,the HAMD-17 scores of the group without early improvement were not significantly decreased after the second ECT to the end.Part FourBaseline cognitive function predicts ECT efficacy in patients with treatment-resistant depressionMethodsThe Martrics Consensus Cognitive Battery(MCCB)was used to score the verbal learning,working memory,visual learning,and processing speed of the enrolled patients with treatment-resistant depression.Significant differences in Cognitive domains were used to predict the outcome of treatment.The predictive effect was evaluated by AUC,and the HAMD reduction rate corresponding to the maximum value of Youden index was taken as the cut-off point,and divided into two subgroups.Logistic regression was used to evaluate the therapeutic effect prediction model.If MCCB scores obey normal distribution,paired t-test was used,otherwise,paired Wilcoxon test was performed.ResultsThere were significant differences in verbal learning between the remission and non-remission groups(P=0.033),and the remitters were more likely to have lower verbal learning scores.The baseline verbal learning score was used to predict remission after ECT,with an AUC of 68.9%(95%CI:54.9%-82.9%),according to the baseline verbal learning score(41.5)corresponding to the maximum Youden index(0.389)as the cut-off point,they were divided into high score subgroup and low score subgroup.Those who achieved remission after ECT were more likely to have lower baseline verbal learning score(OR=3.91,P=0.047,95%CI:1.02-14.96).After receiving ECT,there were no significant changes in verbal learning,working memory and visual learning,but the processing speed was improved(P=0.003).ConclusionsPatients with depression who had lower speech learning scores were more likely to achieve remission after ECT.The cognitive function of the depressed patients after ECT was not significantly impaired,and their processing speed was improved. |
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