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Factors causing a relapse of major depressive disorders following successful electroconvulsive therapy : A retrospective cohort study

KURIMOTO Naoki 20567078 0000-0003-2400-0366 INAGAKI Takahiko 20535348 0000-0002-1605-7170 AOKI Takashi 0000-0002-9075-5751 KADOTANI Hiroshi 90362516 0000-0001-7474-3315 KURIMOTO Fujiki 0000-0003-3005-6198 KURIYAMA Kenichi 00415580 0000-0002-0254-4357 YAMADA Naoto 50166724 0000-0002-5189-3131 OZEKI Yuji 90303768 0000-0002-9516-0941 滋賀医科大学

2021.10.19

概要

BACKGROUND:
Electroconvulsive therapy (ECT) is used to treat major depressive disorder (MDD). Relapse is often observed even after successful ECT, followed by adequate pharmaceutical treatment for MDD.
AIM:
To investigate the diagnostic factors and treatment strategies associated with depression relapse.
METHODS:
We analyzed the relationships between relapse, the diagnostic change from MDD to bipolar disorder (BP), and treatment after the initial ECT. We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital. The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.
RESULTS:
Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study. Compared with the MDD participants, more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission (65.6% vs 15.1%, P < 0.001; relative risk = 4.35, 95%CI: 2.19-8.63, P < 0.001). Twenty-nine patients experienced relapses during the three-year follow-up. In 21 (72.4%, 21/29) patients with relapse, the diagnosis was changed from MDD to BP. The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients (9.63 ± 10.4 mo vs 3.38 ± 3.77 mo, P = 0.022); for most patients, the interval was less than one month. The relative risk of depressive symptoms based on diagnostic changes was 4.35 (95% confidence interval: 2.19–8.63, P < 0.001), and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756 (95%CI: 0.562-0.895, P = 0.007).
CONCLUSION:
It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.

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