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Long-term Outcome Following Electroconvulsive Therapy for Late-Life Depression: Five-Year Follow-up Data From the MODECT Study

      Highlights

      • What is the primary question addressed by this study?
      • Relapse, cognitive impairment and survival were addressed in a cohort consisting of patients suffering from severe late-life depression treated with electroconvulsive therapy, covering a 5-year follow-up period.
      • What is the main finding of this study?
      • Five years after a course of electroconvulsive therapy for severe late-life depression, two thirds of patients relapsed, 39% showed cognitive impairment and 28% was deceased.
      • What is the meaning of the finding?
      • Five-year outcome after a course of electroconvulsive therapy for severe late-life depression seems to be in line with long-term outcome following other acute treatments for severe late-life depression in terms of relapse, cognitive impairment and survival.

      ABSTRACT

      Objective

      Electroconvulsive therapy (ECT) is the most effective treatment for late-life depression (LLD). Research addressing long-term outcome following an acute course of ECT for LLD is limited. We aimed to describe relapse, cognitive impairment and survival 5 years after a treatment with ECT for severe LLD, and assess the association of clinical characteristics with all three outcome measures.

      Methods

      This cohort study was part of the Mood Disorders in Elderly treated with ECT (MODECT) study, which included patients aged 55 years and older with major depressive disorder. Data regarding clinical course, cognitive impairment and mortality were collected 5 years after the index ECT course. We used multivariable Cox proportional hazards models and logistic regression models to assess the association of clinical characteristics with relapse and survival, and cognitive impairment, respectively.

      Results

      We studied 110 patients with a mean age of 72.9 years. 67.1% of patients who showed response at the end of the index ECT course relapsed, and the included clinical characteristics were not significantly associated with the risk of relapse. 38.8% of patients with available data showed cognitive impairment at five-year follow-up. 27.5% were deceased; higher age and a higher number of previous psychiatric admissions were significantly associated with increased risk of mortality.

      Conclusions

      Five-year outcome after a course of ECT for severe LLD seems to be in line with long-term outcome following other acute treatments for severe LLD in terms of relapse, cognitive impairment and survival. Additional studies aimed at improving long-term outcome in severe LLD are warranted.

      Key Words

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