EFFICACY AND LONG-TERM CLINICAL OUTCOME OF COMORBID POSTTRAUMATIC STRESS DISORDER AND MAJOR DEPRESSIVE DISORDER AFTER ELECTROCONVULSIVE THERAPY

Naser Ahmadi, Lori Moss, Edwin Simon, Charles Nemeroff, Nutan Atre-Vaidya

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Many patients fulfill criteria for both posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Electroconvulsive therapy (ECT) is generally acknowledged to be the most-effective treatment for refractory MDD. This study investigated the efficacy of ECT on long-term clinical outcome of comorbid PTSD and MDD. Methods: This retrospective nested matched case-control study is inclusive of 22,164 subjects [3,485 with comorbid MDD and PTSD (92 with ECT and 3,393 without ECT) and 18,679 without MDD and PTSD]. Results: Using the clinical global impression scale (CGI) to assess efficacy, more-robust improvement of PTSD and MDD symptoms was observed with ECT (90%), compared to antidepressant-treatment alone(50%) (P = 0.001). During the median of 8 years of follow-up, the death-rate was 8% in subjects without PTSD and MDD, 9.7% in PTSD and MDD treated with ECT and 18% in PTSD and MDD without ECT (P < 0.05). The suicide-rate was 2.2 and 5.9% in PTSD and MDD with and without ECT-treatment, respectively (P < 0.05). Survival-analyses revealed that the relative-risk of cardiovascular and all-cause mortality is not significantly different in patients with comorbid MDD and PTSD treated with ECT, compared to a matched-cohort without PTSD and MDD (P > 0.05). The relative risk of suicidality, all-cause, and cardiovascular mortality was reduced 64, 65, and 46% in MDD and PTSD patients treated with ECT, compared to those without ECT (P < 0.05). Conclusion: ECT is associated with a significant reduction of symptoms of PTSD and MDD, as well as reduction in risk of suicidality, cardiovascular, and all-cause mortality in MDD and PTSD, an effect more robust than antidepressant-therapy alone.

Original languageEnglish (US)
Pages (from-to)640-647
Number of pages8
JournalDepression and Anxiety
Volume33
Issue number7
DOIs
StatePublished - Jul 1 2016

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Electroconvulsive Therapy
Major Depressive Disorder
Post-Traumatic Stress Disorders
Antidepressive Agents
Mortality
Case-Control Studies
Risk Reduction Behavior
Therapeutics

Keywords

  • electroconvulsive therapy
  • major depressive disorder
  • mortality
  • outcome
  • posttraumatic stress disorder
  • suicide

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

EFFICACY AND LONG-TERM CLINICAL OUTCOME OF COMORBID POSTTRAUMATIC STRESS DISORDER AND MAJOR DEPRESSIVE DISORDER AFTER ELECTROCONVULSIVE THERAPY. / Ahmadi, Naser; Moss, Lori; Simon, Edwin; Nemeroff, Charles; Atre-Vaidya, Nutan.

In: Depression and Anxiety, Vol. 33, No. 7, 01.07.2016, p. 640-647.

Research output: Contribution to journalArticle

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abstract = "Background: Many patients fulfill criteria for both posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Electroconvulsive therapy (ECT) is generally acknowledged to be the most-effective treatment for refractory MDD. This study investigated the efficacy of ECT on long-term clinical outcome of comorbid PTSD and MDD. Methods: This retrospective nested matched case-control study is inclusive of 22,164 subjects [3,485 with comorbid MDD and PTSD (92 with ECT and 3,393 without ECT) and 18,679 without MDD and PTSD]. Results: Using the clinical global impression scale (CGI) to assess efficacy, more-robust improvement of PTSD and MDD symptoms was observed with ECT (90{\%}), compared to antidepressant-treatment alone(50{\%}) (P = 0.001). During the median of 8 years of follow-up, the death-rate was 8{\%} in subjects without PTSD and MDD, 9.7{\%} in PTSD and MDD treated with ECT and 18{\%} in PTSD and MDD without ECT (P < 0.05). The suicide-rate was 2.2 and 5.9{\%} in PTSD and MDD with and without ECT-treatment, respectively (P < 0.05). Survival-analyses revealed that the relative-risk of cardiovascular and all-cause mortality is not significantly different in patients with comorbid MDD and PTSD treated with ECT, compared to a matched-cohort without PTSD and MDD (P > 0.05). The relative risk of suicidality, all-cause, and cardiovascular mortality was reduced 64, 65, and 46{\%} in MDD and PTSD patients treated with ECT, compared to those without ECT (P < 0.05). Conclusion: ECT is associated with a significant reduction of symptoms of PTSD and MDD, as well as reduction in risk of suicidality, cardiovascular, and all-cause mortality in MDD and PTSD, an effect more robust than antidepressant-therapy alone.",
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