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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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| Published in: | JAMA network open 2024, Vol.7 (7), p.e2422738 |
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| creator | Gillving, Cecilia Ekman, Carl Johan Hammar, Åsa Landén, Mikael Lundberg, Johan Movahed Rad, Pouya Nordanskog, Pia von Knorring, Lars Nordenskjöld, Axel |
| description | 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 |
| doi_str_mv | 10.1001/jamanetworkopen.2024.22738 |
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| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_878393</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3142343771</sourcerecordid><originalsourceid>FETCH-LOGICAL-c530t-f1f8c148d4fcbe455d3b0b41cfb3df6dca97a7dd2cabe1bec34f153aad26c8983</originalsourceid><addsrcrecordid>eNqNkk1v1DAQhiMEolXpX0ARXDiQxfbYic2t6pYPsYgDhavlryzZZuPUjluVX4_3gxWq1IqD5dH4mXdG47coXmE0wwjhdyu1VoObbn248qMbZgQROiOkAf6kOCasoRVwxJ7-Ex8VpzGuEEIEYRA1e14cgUCMEEGOiy_fXfc7BVfOU1BT54dSDba86J2Zgjd-uEl97G5cefnLBTXeld1QflUrH8q5G4OL27d5F32wLrwonrWqj-50f58UPz5cXJ5_qhbfPn4-P1tUhgGaqha33GDKLW2NdpQxCxppik2rwba1NUo0qrGWGKUd1s4AbTEDpSypDRccTopqpxtv3Zi0HEO3VuFOetXJfeoqR07yhoOAzC8e5Ps05qPz2RS4GinNmJLUgJAUMSF1LYgEgbm1LQBh9NH2yyyXU8utGmQBQJl_-yA_736eSR-WMiXJoEGYPCp_wH1IEuelcPF_fN8lSVANaDP-mx0_Bn-dXJzkuovG9X22lU9RAuK0aZDAm8W9voeufApD_lsJmBKg0DQ4U-93lAk-xuDawwgYyY1n5T3Pyo1n5dazufjlvkXSa2cPpX8dCn8AIOzu9w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3142343771</pqid></control><display><type>article</type><title>Seizure Duration and Electroconvulsive Therapy in Major Depressive Disorder</title><source>Publicly Available Content Database</source><creator>Gillving, Cecilia ; Ekman, Carl Johan ; Hammar, Åsa ; Landén, Mikael ; Lundberg, Johan ; Movahed Rad, Pouya ; Nordanskog, Pia ; von Knorring, Lars ; Nordenskjöld, Axel</creator><creatorcontrib>Gillving, Cecilia ; Ekman, Carl Johan ; Hammar, Åsa ; Landén, Mikael ; Lundberg, Johan ; Movahed Rad, Pouya ; Nordanskog, Pia ; von Knorring, Lars ; Nordenskjöld, Axel</creatorcontrib><description>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 < .001). Anticonvulsant medications were associated with shorter seizure duration (eg, lamotrigine: β coefficient [SE], -6.02 [1.08]; P < .001) and lower remission rates (eg, lamotrigine: adjusted OR, 0.67; 95% CI, 0.53-0.84; P < .001).
This study found an association between seizure length and remission from MDD. Use of anticonvulsant medication during ECT was associated with shorter seizure duration and lower remission rates after ECT.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2024.22738</identifier><identifier>PMID: 39052292</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>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</subject><ispartof>JAMA network open, 2024, Vol.7 (7), p.e2422738</ispartof><rights>2024. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c530t-f1f8c148d4fcbe455d3b0b41cfb3df6dca97a7dd2cabe1bec34f153aad26c8983</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,4010,27904,27905,27906,36993,36994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39052292$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-206304$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-115389$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-537012$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/340530$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/e60ab55a-4c39-4059-b692-3918ddf33254$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:159155951$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Gillving, Cecilia</creatorcontrib><creatorcontrib>Ekman, Carl Johan</creatorcontrib><creatorcontrib>Hammar, Åsa</creatorcontrib><creatorcontrib>Landén, Mikael</creatorcontrib><creatorcontrib>Lundberg, Johan</creatorcontrib><creatorcontrib>Movahed Rad, Pouya</creatorcontrib><creatorcontrib>Nordanskog, Pia</creatorcontrib><creatorcontrib>von Knorring, Lars</creatorcontrib><creatorcontrib>Nordenskjöld, Axel</creatorcontrib><title>Seizure Duration and Electroconvulsive Therapy in Major Depressive Disorder</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>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 < .001). Anticonvulsant medications were associated with shorter seizure duration (eg, lamotrigine: β coefficient [SE], -6.02 [1.08]; P < .001) and lower remission rates (eg, lamotrigine: adjusted OR, 0.67; 95% CI, 0.53-0.84; P < .001).
This study found an association between seizure length and remission from MDD. Use of anticonvulsant medication during ECT was associated with shorter seizure duration and lower remission rates after ECT.</description><subject>Adult</subject><subject>Aged</subject><subject>Allmän medicin</subject><subject>Anticonvulsants</subject><subject>Clinical Medicine</subject><subject>Cohort Studies</subject><subject>Convulsions & seizures</subject><subject>Depressive Disorder, Major - therapy</subject><subject>Electroconvulsive therapy</subject><subject>Electroconvulsive Therapy - methods</subject><subject>Electroencephalography</subject><subject>Family Medicine</subject><subject>Female</subject><subject>Humans</subject><subject>Klinisk medicin</subject><subject>Male</subject><subject>Medical and Health Sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Mental depression</subject><subject>Middle Aged</subject><subject>Psychiatry</subject><subject>Psykiatri</subject><subject>Registries</subject><subject>Seizures - therapy</subject><subject>Sweden</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqNkk1v1DAQhiMEolXpX0ARXDiQxfbYic2t6pYPsYgDhavlryzZZuPUjluVX4_3gxWq1IqD5dH4mXdG47coXmE0wwjhdyu1VoObbn248qMbZgQROiOkAf6kOCasoRVwxJ7-Ex8VpzGuEEIEYRA1e14cgUCMEEGOiy_fXfc7BVfOU1BT54dSDba86J2Zgjd-uEl97G5cefnLBTXeld1QflUrH8q5G4OL27d5F32wLrwonrWqj-50f58UPz5cXJ5_qhbfPn4-P1tUhgGaqha33GDKLW2NdpQxCxppik2rwba1NUo0qrGWGKUd1s4AbTEDpSypDRccTopqpxtv3Zi0HEO3VuFOetXJfeoqR07yhoOAzC8e5Ps05qPz2RS4GinNmJLUgJAUMSF1LYgEgbm1LQBh9NH2yyyXU8utGmQBQJl_-yA_736eSR-WMiXJoEGYPCp_wH1IEuelcPF_fN8lSVANaDP-mx0_Bn-dXJzkuovG9X22lU9RAuK0aZDAm8W9voeufApD_lsJmBKg0DQ4U-93lAk-xuDawwgYyY1n5T3Pyo1n5dazufjlvkXSa2cPpX8dCn8AIOzu9w</recordid><startdate>2024</startdate><enddate>2024</enddate><creator>Gillving, Cecilia</creator><creator>Ekman, Carl Johan</creator><creator>Hammar, Åsa</creator><creator>Landén, Mikael</creator><creator>Lundberg, Johan</creator><creator>Movahed Rad, Pouya</creator><creator>Nordanskog, Pia</creator><creator>von Knorring, Lars</creator><creator>Nordenskjöld, Axel</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DG8</scope><scope>AABEP</scope><scope>D8T</scope><scope>D91</scope><scope>ZZAVC</scope><scope>ACNBI</scope><scope>DF2</scope><scope>F1U</scope><scope>AGCHP</scope><scope>D95</scope></search><sort><creationdate>2024</creationdate><title>Seizure Duration and Electroconvulsive Therapy in Major Depressive Disorder</title><author>Gillving, Cecilia ; 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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 < .001). Anticonvulsant medications were associated with shorter seizure duration (eg, lamotrigine: β coefficient [SE], -6.02 [1.08]; P < .001) and lower remission rates (eg, lamotrigine: adjusted OR, 0.67; 95% CI, 0.53-0.84; P < .001).
This study found an association between seizure length and remission from MDD. Use of anticonvulsant medication during ECT was associated with shorter seizure duration and lower remission rates after ECT.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>39052292</pmid><doi>10.1001/jamanetworkopen.2024.22738</doi><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Seizure Duration and Electroconvulsive Therapy in Major Depressive Disorder |
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