A Retrospective Analysis of the Impact of Electroconvulsive Therapy on Anxiety Severity in Patients with Treatment Resistant Depression Restricted; Files Only
Laszcz, Julia (Spring 2024)
Abstract
Background
In major depressive disorder (MDD), anxiety is present in 40-60% of patients. Electroconvulsive therapy (ECT) is an effective treatment for treatment-resistant depression (TRD). There is limited data regarding the improvement of symptoms of anxiety in patients receiving ECT for TRD.
Methods
A retrospective chart review of TRD patients who received an acute ECT course in an outpatient setting was conducted. Symptomatic response was measured using the Beck Depression Inventory-II (BDI-II) and Generalized Anxiety Disorder-7 Scale (GAD7). Two generalized estimating equation (GEE) models were conducted to assess the degree of change in anxious symptoms relative to the change in depressive symptoms. The GEE models also included pre-treatment depression scores and ECT electrode placement (right unilateral, bifrontal, bitemporal) as covariates.
Results
117 patients with unipolar or bipolar depression were analyzed. Symptoms of both depression (-0.09, p < 0.001) and anxiety (-0.08, p < 0.001) improved after ECT treatment, with a greater standardized decrease for symptoms of depression. Higher levels of anxiety were associated with a smaller improvement in depression.
Conclusions
Co-occurring symptoms of anxiety in TRD patients are not a contraindication for ECT. However, anxiety symptoms show a more modest improvement throughout an acute course and their presence may be associated with a smaller improvement in depression. This knowledge may play a role in decisions regarding treatment options for TRD patients.
Table of Contents
Background ............................................................................................................................. 9
Methods .................................................................................................................................. 11
Results .................................................................................................................................... 15
Discussion ............................................................................................................................ 17
Tables and Figures ................................................................................................................ 20
Table 1: Descriptive Statistics 20
Table 2: Parameter estimate for a GEE Model Fitted to Estimate Variation in BDI-II over the course of ECT treatment 21
Table 3: Parameter estimate for a GEE Model Fitted to Estimate Variation in GAD7 over the course of ECT treatment 22
Figure 1. Linear regression to illustrate the trajectory of depression and anxiety severity, respectively, over the course of up to 20 ECT sessions 23
Figure 2. Histogram of final BDI-II scores at the last
session of the acute course 24
Figure 3. Histogram of final GAD7 scores at the last session of the acute course 25
References.................................................................................................................................. 26
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