Predictors of the Response and Relapse/Recurrence After ECT for Depressed Patients
Predictors of the Response and Relapse/Recurrence After ECT for Depressed Patients
Objective: Psychiatrists have long sought a quantifiable biomarker of electroconvulsive
 therapy (ECT) response. Although ECT is highly effective for treatment of patients with major
 depressive episode, a high rate of relapse/recurrence is a major problem after
 discontinuation of ECT. The purpose of this study is to examine the factors related to the
 response of ECT, to predict ECT response early, and to investigate the clinical predictors
 affecting the time to relapse/recurrence after ECT.

 Methods: Patients with major depressive episode who require ECT treatment will be enrolled.
 ECT will be performed regularly. The 17-item Hamilton Rating Scale for Depression (HAMD-17)
 and other scales will be assessed before ECT, after every 10 days, till to an expected
 average of 50 days, and monthly during the 6-month follow-up period. Other measures also will
 be performed before the first ECT, at an expected average of 50 days, and at the end of
 follow-up period. Predictors of the response and relapse/recurrence after ECT and early
 prediction of ECT response will be obtained by statistic methods.
Objective: Electroconvulsive therapy (ECT) is a safe and the most effective treatment for
 patients with major depressive episode, but the mechanism underlying the therapeutic action
 of this treatment is still unknown. Psychiatrists have long sought a quantifiable biomarker
 of ECT treatment response. Till now, no biomarker of ECT is used in clinical practice, but
 potential biomarkers that have been studied include brain-derived neurotrophic factor (BDNF),
 DNA polymorphism, RNA, electroencephalogram (EEG), auditory evoked potential (AEP), and
 cognitive function test. Although ECT is highly effective for treatment of major depressive
 episode, a high rate of relapse/recurrence is a major problem after discontinuation of ECT.
 The purpose of this study is to examine the factors related to the response of ECT for
 patients with major depressive episode, to predict the ECT response, and to investigate the
 clinical predictors affecting the time to relapse/recurrence after ECT.

 Methods: Subjects with major depressive episode diagnosed according to DSM-IV criteria who
 require ECT treatment will be enrolled for study. ECT will be performed regularly using a
 brief-pulse, constant-current device. ECT will be given two or three times a week. The
 17-item Hamilton Rating Scale for Depression (HAMD-17), Clinical Global Impression-severity
 (CGI-S), global assessment scale (GAF), UKU side effect rating scale and other scales will be
 assessed before ECT, after every 10 days, till to an expected average of 50 days, and monthly
 during the 6-month follow-up period. Response will be defined as a reduction of 60% or more
 of the HAMD-17 score after treatment. Other measures collected before ECT and at an expected
 average of 50 days include Zung's Depression Scale (SDS), Short-Form 36 (SF-36), Work and
 Social Adjustment Scale (WSAS), plasma BDNF level, auditory evoked potentials (AEP),
 electroencephalography (EEG), neuropsychological test, and RNA. After ECT, CGI-S, HAMD-17,
 GAF and WSAS are reexamined monthly for 6 months. The definition of relapse/recurrence will
 be readmission, a HAM-D-17 score at least 18, or a CGI-S score at least 4 during the
 follow-up period. A logistic regression model will be used to obtain the predictors for ECT
 response. To establish the early prediction of ECT response, receiver operating
 characteristic curve (ROC) will be used to determine the cutoff point. Possible predictors
 related to relapse/recurrence will be analyzed using the Cox proportional hazards regression
 model.
Inclusion Criteria:

 -  Clinical diagnosis of major depressive disorder or bipolar depression

 -  Poor drug response

 -  Severity or urgency of illness

 Exclusion Criteria:

 -  Subjects cannot write the imform consents

 -  Subjects with severe physical illness