{"id":550,"date":"2024-11-11T08:34:02","date_gmt":"2024-11-11T08:34:02","guid":{"rendered":"https:\/\/dutchectconsortium.nl\/?p=550"},"modified":"2024-12-04T18:53:23","modified_gmt":"2024-12-04T18:53:23","slug":"prediction-of-ect-effectiveness","status":"publish","type":"post","link":"https:\/\/dutchectconsortium.nl\/index.php\/2024\/11\/11\/prediction-of-ect-effectiveness\/","title":{"rendered":"Prediction of ECT effectiveness"},"content":{"rendered":"<style>.kb-row-layout-id550_ee55c0-bd > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id550_ee55c0-bd > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id550_ee55c0-bd > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:900px;padding-top:25px;padding-bottom:85px;grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id550_ee55c0-bd{background-color:#fff;}.kb-row-layout-id550_ee55c0-bd > .kt-row-layout-overlay{opacity:0.30;}.kb-row-layout-id550_ee55c0-bd .kt-row-layout-bottom-sep{height:100px;}.kb-row-layout-id550_ee55c0-bd .kt-row-layout-bottom-sep svg{width:100%;}.kb-row-layout-id550_ee55c0-bd .kt-row-layout-bottom-sep svg{fill:#ffffff!important;}@media all and (max-width: 1024px){.kb-row-layout-id550_ee55c0-bd > .kt-row-column-wrap{grid-template-columns:repeat(2, minmax(0, 1fr));}}@media all and (max-width: 1024px){.kb-row-layout-id550_ee55c0-bd .kt-row-layout-bottom-sep{height:px;}}@media all and (max-width: 1024px){.kb-row-layout-id550_ee55c0-bd .kt-row-layout-bottom-sep svg{width:%;}}@media all and (max-width: 767px){.kb-row-layout-id550_ee55c0-bd > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id550_ee55c0-bd .kt-row-layout-bottom-sep{height:px;}.kb-row-layout-id550_ee55c0-bd .kt-row-layout-bottom-sep svg{width:%;}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id550_ee55c0-bd alignnone kt-row-has-bg wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-2-columns kt-row-layout-row kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column550_0ba363-19 > .kt-inside-inner-col,.kadence-column550_0ba363-19 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column550_0ba363-19 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column550_0ba363-19{position:relative;}<\/style>\n<div class=\"wp-block-kadence-column kadence-column550_0ba363-19 inner-column-2\"><div class=\"kt-inside-inner-col\">\n<p class=\"has-larger-font-size\">A prediciton model for electroconvulsive therapy effectiveness in patients with major depressive disorder from the Dutch ECT Consortium (DEC)<\/p>\n\n\n\n<p class=\"has-text-align-left has-small-font-size\">D. Loef, A.W. Hoogendoorn, M. Somers, R.J.T. Mocking, D.S. Scheepens, K.W.F. Scheepstra, M. Blijleven, J.M. Hegeman, K.S. van den Berg, B. Schut, T.K. Birkenhager, W. Heijnen, D. Rhebergen, M.L. Oudega, S.N.T.M. Schouws, E. van Exel, B.P.F. Rutten, B.F.P. Broekman, A.C.M. Vergouwen, T.J.C. Zoon, R.M. Kok, K. Somers, E. Verwijk, J.J.E. Rovers, G. Schuur, J.A. van Waarde, J.P.A.J. Verdijk, D. Bloemkolk, F.L. Gerritse, H. van Welie, B.C.M. Haarman, S.M. van Belkum, M. Vischjager, K. Hagoort, E. van Dellen, I. Tendolkar, P.F.P van Eijndhoven, &amp; A. Dols<\/p>\n\n\n\n<h3 class=\"wp-block-heading has-regular-font-size\" id=\"st0010\" style=\"font-style:normal;font-weight:100;text-transform:none\">Reliable predictors for electroconvulsive therapy (ECT) effectiveness would allow a more precise and personalized approach for the treatment of major depressive disorder (MDD). Prediction models were created using a priori selected clinical variables based on previous meta-analyses. Multivariable linear regression analysis was used, applying backwards selection to determine predictor variables while allowing non-linear relations, to develop a prediction model for depression outcome post-ECT (and logistic regression for remission and response as secondary outcome measures). Internal validation and internal-external cross-validation were used to examine overfitting and generalizability of the model\u2019s predictive performance. In total, 1892 adult patients with MDD were included from 22 clinical and research cohorts of the twelve sites within the Dutch ECT Consortium. The final primary prediction model showed several factors that significantly predicted a lower depression score post-ECT: higher age, shorter duration of the current depressive episode, severe MDD with psychotic features, lower level of previous antidepressant resistance in the current episode, higher pre-ECT global cognitive functioning, absence of a comorbid personality disorder, and a lower level of failed psychotherapy in the current episode. The optimism-adjusted R\u00b2 of the final model was 19%. This prediction model based on readily available clinical information can reduce uncertainty of ECT outcomes and hereby inform clinical decision-making, as prompt referral for ECT may be particularly beneficial for individuals with the above-mentioned characteristics. However, despite including a large number of pretreatment factors, a large proportion of the variance in depression outcome post-ECT remained unpredictable.<\/h3>\n\n\n\n<p><a href=\"Abstract\nIntroduction: Major depressive disorder (MDD) is a common psychiatric disorder. Despite several treatment options, a subgroup of patients will not respond to\nthe commonly used antidepressant treatments and thus express treatment resistance (TRD). TRD can be quantified with the Dutch Measure for Treatment Resistance in Depression (DM-TRD). Electroconvulsive therapy (ECT) is an effective\ntreatment for MDD, also in TRD. Yet, the position of ECT as \u201ctreatment-of-lastresort\u201d may decrease the likelihood of beneficial outcome. Our aim was to investigate the association between treatment resistance and outcome and course of ECT.\nMethods: We performed a retrospective, multicenter cohort study with\n440 patients of which data was retrieved from patient records as collected in\nthe Dutch ECT Cohort database. Linear and logistic regression models were\nused to explore the association between level of treatment resistance and outcome of ECT. Median split was used to explore the differences between high\nand low level of TRD and course of treatment.\nResults: A higher DM-TRD score was associated with significantly smaller\nreduction of depression symptoms (R2 = 0.160; \u03b2 = \u00012.968; p < 0.001) and\nlower chance of response (OR = 0.821 [95 CI: 0.760\u20130.888]; \u03b2 = \u00010.197;\np < 0.001). Low level TRD patients underwent fewer ECT sessions (mean 13\n\u00b1 6 SD vs. 16 \u00b1 7 SD; p < 0.001) and fewer switches from right unilateral tot\nbifrontotemporal electrode placement (29% vs. 40%; p = 0.032).\nConclusion: Reserving ECT as \u201ctreatment-of-last-resort\u201d in the treatment\nalgorithm for MDD seems questionable, because in our study lower level of\ntreatment resistance predicted more beneficial ECT-outcome. Moreover, providing ECT in less treatment resistant patients showed fewer needed ECTsessions and less switches to BL electrode placement, which may decrease the\nrisk for cognitive side-effects.\"><br><br><\/a><\/p>\n<\/div><\/div>\n\n\n<style>.kadence-column550_4757f9-19 > .kt-inside-inner-col,.kadence-column550_4757f9-19 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column550_4757f9-19 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column550_4757f9-19{position:relative;}<\/style>\n<div class=\"wp-block-kadence-column kadence-column550_4757f9-19\"><div class=\"kt-inside-inner-col\"><\/div><\/div>\n\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>A prediciton model for electroconvulsive therapy effectiveness in patients with major depressive disorder from the Dutch ECT Consortium (DEC) D. Loef, A.W. Hoogendoorn,&hellip;<\/p>\n","protected":false},"author":1,"featured_media":565,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[],"class_list":["post-550","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-research"],"_links":{"self":[{"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/posts\/550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/comments?post=550"}],"version-history":[{"count":3,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/posts\/550\/revisions"}],"predecessor-version":[{"id":569,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/posts\/550\/revisions\/569"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/media\/565"}],"wp:attachment":[{"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/media?parent=550"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/categories?post=550"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/tags?post=550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}