Seizure Duration and Electroconvulsive Therapy in Major Depressive Disorder

Electroconvulsive therapy (ECT), wherein a generalized epileptic seizure is induced, is a treatment for major depressive disorder (MDD). Currently, it is unclear whether there is an association between seizure length and treatment outcome. To explore the association between seizure duration, potenti...

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Bibliographic Details
Published in:JAMA network open 2024, Vol.7 (7), p.e2422738
Main Authors: Gillving, Cecilia, Ekman, Carl Johan, Hammar, Åsa, Landén, Mikael, Lundberg, Johan, Movahed Rad, Pouya, Nordanskog, Pia, von Knorring, Lars, Nordenskjöld, Axel
Format: Article
Language:English
Subjects:
Adult
Aged
Allmän medicin
Anticonvulsants
Clinical Medicine
Cohort Studies
Convulsions & seizures
Depressive Disorder, Major - therapy
Electroconvulsive therapy
Electroconvulsive Therapy - methods
Electroencephalography
Family Medicine
Female
Humans
Klinisk medicin
Male
Medical and Health Sciences
Medicin och hälsovetenskap
Mental depression
Middle Aged
Psychiatry
Psykiatri
Registries
Seizures - therapy
Sweden
Time Factors
Treatment Outcome
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Summary:Electroconvulsive therapy (ECT), wherein a generalized epileptic seizure is induced, is a treatment for major depressive disorder (MDD). Currently, it is unclear whether there is an association between seizure length and treatment outcome. To explore the association between seizure duration, potential confounding variables, and ECT treatment outcome. This population-based cohort study obtained data from the Swedish National Quality Register for ECT. Patients treated for unipolar MDD with unilateral electrode placement between January 1, 2012, and December 31, 2019, were included. The electroencephalographic (EEG) seizure duration from the first ECT treatment session for each patient was used for analysis. Data analyses were performed between March 2021 and May 2024. The primary outcome was remission, defined as a cutoff score of less than 10 points on the self-assessment version of the Montgomery-Åsberg Depression Rating Scale within 1 week after ECT. Multivariate logistic regression analysis was performed to calculate odds ratios (ORs) between different seizure duration groups. Furthermore, the associations between concomitant use of pharmacological treatments, seizure duration, and remission rate were explored. Among the 6998 patients included, 4229 (60.4%) were female and the mean (SD) age was 55.2 (18.6) years. Overall, 2749 patients (39.3%) achieved remission after ECT. Patients with EEG seizure duration of 60 to 69 seconds had the highest remission rates compared with patients with seizure duration of less than 20 seconds (OR, 2.17; 95% CI, 1.63-2.88; P 
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2024.22738