The Efficacy of Acute Electroconvulsive Therapy in Atypical Depression

Objective: This study examined the characteristics and outcomes of patients with major depressive disorder (MDD), with or without atypical features, who were treated with acute bilateral electroconvulsive therapy (ECT).

Method: Analyses were conducted with 489 patients who met DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the basis of the Structured Clinical Interview for DSM-IV obtained at baseline prior to ECT. Depression symptom severity was measured by the 24-item Hamilton Rating Scale for Depression (HAM-D₂₄) and the 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR₃₀). Remission was defined as at least a 60% decrease from baseline in HAM-D₂₄ score and a total score of 10 or below on the last 2 consecutive HAM-D₂₄ ratings. The randomized controlled trial was performed from 1997 to 2004.

Results: The typical (N = 453) and atypical (N = 36) groups differed in several sociodemographic and clinical variables including gender (p = .0071), age (p = .0005), treatment resistance (p = .0014), and age at first illness onset (p < .0001) and onset of current episode (p = .0008). Following an acute course of bilateral ECT, a considerable portion of both the typical (67.1%) and the atypical (80.6%) groups reached remission. The atypical group was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group after adjustment for age, psychosis, gender, clinical site, and depression severity based on the HAM-D₂₄.

Conclusion: Acute ECT is an efficacious treatment for depressed patients with typical or atypical symptom features.