Published online Oct 19, 2021. doi: 10.5498/wjp.v11.i10.841
Peer-review started: March 28, 2021
First decision: July 15, 2021
Revised: July 26, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 19, 2021
Processing time: 200 Days and 19.4 Hours
Electroconvulsive therapy (ECT) is used to treat major depressive disorder (MDD). Relapse is often observed even after successful ECT, followed by adequate pharmaceutical treatment for MDD.
To investigate the diagnostic factors and treatment strategies associated with depression relapse.
We analyzed the relationships between relapse, the diagnostic change from MDD to bipolar disorder (BP), and treatment after the initial ECT. We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital. The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.
Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study. Compared with the MDD participants, more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission (65.6% vs 15.1%, P < 0.001; relative risk = 4.35, 95%CI: 2.19-8.63, P < 0.001). Twenty-nine patients experienced relapses during the three-year follow-up. In 21 (72.4%, 21/29) patients with relapse, the diagnosis was changed from MDD to BP. The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients (9.63 ± 10.4 mo vs 3.38 ± 3.77 mo, P = 0.022); for most patients, the interval was less than one month. The relative risk of depressive symptoms based on diagnostic changes was 4.35 (95% confidence interval: 2.19–8.63, P < 0.001), and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756 (95%CI: 0.562-0.895, P = 0.007).
It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.
Core Tip: Patients who are diagnosed with major depressive disorder (MDD) but repeatedly relapse after electroconvulsive therapy (ECT) and require continuation and/or maintenance electroconvulsive therapy (C/M-ECT) may be in the depressive phase of bipolar disorder (BP). Rather than repeating C/M-ECT alone, even without obvious manic symptoms, the treatment for MDD may have to be revised to that for BP for patients who relapse within one month.