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 Shane McCarron, Ger Ryan, Lucy Kiely

Presentation outline Depression Electroconvulsive therapy Aim Methodology Results

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 Weight Sleep Concentration Psychomotor agitation/ retardation Fatigue Worthlessness/ guilt Suicidal thoughts The symptoms cause clinically significant impairment in functioning

Electroconvulsive therapy Kavanagh & McLoughlin 2009

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 (ISRCTN ) – 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 Age56.7 (15.0)59.1 (13.8) (98) P = Female29 (58%)31 (62%) (1)P = Clinical details Baseline HDRS30.3 (6.8)29.3 (7.0)0.720 (98) P = Baseline BDI II32.1 (11.9)37.2 (13.6) (56) P = Psychotic8 (16%)6 (12%) (1)P = Treatment resistant 25 (50%)30 (60%) (1)P = Previous ECT22 (44%)20 (40%) (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)

HRQOL 6 months after ECT for severe depression compared to “normal” population

Predicting HRQOL 6 months after ECT for severe depression

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

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.