Risk factors of relapse after successful electroconvulsive therapy for Taiwanese patients with major depression
Abstract
OBJECTIVES: Major depressive disorder is a recurrent illness. Treatment strategies are generally focused on achieving remission and preventing relapse/recurrence. The aim of this study was to explore the risk factors associated with relapse for remitted patients during the 12-week follow-up. METHODS: This was an open-label trial for major depressive disorder patients receiving acute treatments with electroconvulsive therapy (ECT) and continuation medication in the 12-week follow-up. Symptom severity and psychosocial functioning were assessed using the 17-item Hamilton Rating Scale for Depression (HAMD-17) and the Work and Social Adjustment Scale at each visit. Remission was defined as a HAMD-17 of 7 or less after acute treatment. Relapse was defined as a HAMD-17 of 14 or greater. Subjects achieving remission after acute treatments were included for analysis. Survival analysis was used to investigate the factors associated with relapse. RESULTS: Sixty patients receiving ECT for acute treatment were enrolled for 12-week follow-up. Using Cox regression analysis, a greater number of previous major depressive episodes and greater baseline Work and Social Adjustment Scale scores were significantly associated with shorter time to relapse. CONCLUSIONS: The goal of acute treatment should focus on functional remission to prevent relapse. Further studies related to more effective treatments to prevent relapse after acute ECT are required in the future.
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20 articles define relapse with psychometric measures (Hamilton Depression Rating Scale, Beck Depression Inventory, Montgomery-Asberg Depression Rating Scale, Goldberg Anxiety and Depression Scale, Clinical Global Impression).
“20 do so with psychometric measures (Hamilton Depression Rating Scale, Beck Depression Inventory, Montgomery-Asberg Depression Rating Scale, Goldberg Anxiety and Depression Scale, Clinical Global Impression) (4, 7, 9, 13–18, 33, 34, 42–49)”
From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [14]
13 of the 20 studies using scales use the Hamilton Depression Rating Scale, with varied score criteria: 8, 12, 14, 16, 18, and up to 20.
“13 of the 20 use the Hamilton Depression Rating Scale, although the score they establish as a criterion is very varied, with some considering a score of 8 points (4) as sufficient for a relapse, others of 12 (20), 14 (13, 14, 44), 16 (17, 18) 18 (47, 49) and up to 20 (9).”
From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [14]
The extracted medians showed substantial heterogeneity, ranging from very early relapse in severe or treatment-resistant samples with medians between 53 and 90 days to substantially longer intervals in maintenance-treated populations (218-294 days).
“The extracted medians showed substantial heterogeneity, ranging from very early relapse in severe or treatment−resistant samples with medians between 53 and 90 days (14, 21, 23, 38) to substantially longer intervals in maintenance−treated populations (218–294 days) (33, 40, 45).”
From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [14]
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Editor’s Roundup for Issue #2 of 2020
McCall, W. V. (2020) · Journal of Ect · doi:10.1097/yct.0000000000000681
Brooks, S. K., Hall, C. E., & Greenberg, N. L. (2023) · Research Square · doi:10.21203/rs.3.rs-3610160/v1
Bamouss, A., Mungo, A., & Hein, M. (2024) · L Encéphale · doi:10.1016/j.encep.2023.11.021
- Authors
- Yang, W.-C., Lin, C.-H., & Chen, C.-C.
- Affiliations
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital (TW)
- Kaohsiung Medical University (TW)
- Corresponding author
- Yang, Wei-Cheng
- Lin, Ching-Hua
- Chen, Cheng-Chung
- Venue
- The Journal of ECT
- Published
- 2019-07-24
- Volume
- 36
- Issue
- 2
- Pages
- 106-110
- ISSN
- 1095-0680 (ISSN-L)
- 1533-4112
- OpenAlex
- W2966567739
- Cited by
- 9
- References
- 47
- Citations by year
- 2026: 3 · 2024: 2 · 2023: 2 · 2022: 1 · 2020: 1
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Ect (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- major depressive disorder, electroconvulsive therapy, relapse, risk factors, remission, recurrence prevention, work and social adjustment, psychosocial functioning, Taiwanese patients, number of depressive episodes
- MeSH terms
- Adult, Combined Modality Therapy, Major Depressive Disorder, Electroconvulsive Therapy, Female, Follow-Up Studies, Humans, Inpatients, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Recurrence, Risk Factors, Social Adjustment, Taiwan, Work, Survival Analysis, Treatment Outcome
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