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Effects of electroconvulsive therapy for depression on health related quality of life

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

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Effects of electroconvulsive therapy for depression on health related quality of life

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  1. Effects of electroconvulsive therapy for depression on health related quality of life Adam Kavanagh

  2. 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

  3. Presentation outline • Depression • Electroconvulsive therapy • Aim • Methodology • Results

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

  5. Electroconvulsive therapy Kavanagh & McLoughlin 2009

  6. 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)

  7. Methodology • EFFECT-DEP TRIAL(ISRCTN23577151) • Design • Location • Inclusion/ Exclusion • Randomization • Primary outcome • Power

  8. 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)

  9. Results

  10. Results

  11. Pre-treatment N (RUL = 36, Bi = 32), 6 months N (RUL = 26, bi = 28), Completed both assessments (RUL = 21, Bi = 22)

  12. Pre-treatment N (RUL = 36, Bi = 32), 6 months N (RUL = 26, bi = 28), Completed both assessments (RUL = 21, Bi = 22)

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

  14. Predicting HRQOL 6 months after ECT for severe depression

  15. 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

  16. 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

  17. 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

  18. Health related quality of life • HRQOL – depression • HRQOL – depression and ECT • HRQOL – depression and ECT and NICE ‘03 + ‘09

  19. 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.

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