Factors causing a relapse of major depressive disorders following successful electroconvulsive therapy: A retrospective cohort study

doi:10.5498/wjp.v11.i10.841

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World Journal of Psychiatry

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Retrospective Cohort Study

World J Psychiatr. Oct 19, 2021; 11(10): 841-853
Published online Oct 19, 2021. doi: 10.5498/wjp.v11.i10.841

Factors causing a relapse of major depressive disorders following successful electroconvulsive therapy: A retrospective cohort study

Naoki Kurimoto, Takahiko Inagaki, Takashi Aoki, Hiroshi Kadotani, Fujiki Kurimoto, Kenichi Kuriyama, Naoto Yamada, Yuji Ozeki

Naoki Kurimoto, Takahiko Inagaki, Takashi Aoki, Hiroshi Kadotani, Kenichi Kuriyama, Naoto Yamada, Yuji Ozeki, Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan

Naoki Kurimoto, Fujiki Kurimoto, Department of Psychiatry, Shigasato Hospital, Otsu 520-0006, Shiga, Japan

Takahiko Inagaki, Department of Psychiatry, Biwako Hospital, Otsu 520-0113, Shiga, Japan

Takashi Aoki, Department of Psychiatry, Shiga Hachiman Hospital, Omihachiman 523-8503, Shiga, Japan

Hiroshi Kadotani, Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan

Kenichi Kuriyama, Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira 187-8502, Tokyo, Japan

Author contributions: Kurimoto N contributed to the conception of the study, acquisition of the data, analysis and interpretation of the data, and drafting of the manuscript; Kuriyama K contributed to the interpretation of the data, drafting the manuscript, critical review, and support of the entire study project; Kadotani H and Yamada N contributed to the analysis and interpretation of the data and critical review; Inagaki T and Aoki T contributed to the acquisition of the data and critical reviews; Kurimoto F and Ozeki Y contributed to the critical review; all authors wrote, read and approved the final manuscript.

Supported by MHLW Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes program, No. 21FA0201; and MEXT/JSPS, No. 17H00872.

Institutional review board statement: The study protocol was approved by the Shiga University of Medical Science Ethics Committee (27-178) and registered in the UMIN-CTR (UMIN000030458).

Informed consent statement: All patients provided informed consent through an opt-out methodology.

Conflict-of-interest statement: NK reports honoraria for lectures from Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Janssen Pharmaceutical K.K. TI reports honoraria for lectures from Otsuka Pharmaceutical Co., Ltd., Yoshitomiyakuhin Corporation, Lundbeck Japan K.K., and Janssen Pharmaceutical K.K.; honoraria for manuscript writing from Kitaohji Syobo, Maruzen Publishing Co., Ltd., and SEIKAISHA Ltd. KK reports grants from Otsuka Pharmaceutical Co., Ltd., Meiji Seika Pharma Co., Ltd., MSD K.K., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd., Pfizer Jaoan Inc., Shionogi Pharma Co., Ltd., Mitsubishi-Tanabe Pharma Corporation, Tsumura and Co., and Kao Corporation, and honoraria for lectures from Meiji Seika Pharma Co., Ltd., Eli Lilly Japan K.K., Eisai Co., Ltd., MSD K.K., Yoshitomiyakuhin Corporation, Tsumura and Co., and Takeda Pharmaceutical Co., Ltd. H.K. is associated with a laboratory that is supported by donations from Fukuda Lifetech Co., Ltd., Fukuda Life Tech Keiji Co., Ltd., Tanaka Sleep Clinic, Akita Sleep Clinic, and AiAi Care Co., Ltd., Shiga University of Medical Science. H.K. received grants from Eisai Co., Ltd., and Merck Sharp and Dohme Corp/MSD K.K. (Investigator-Initiated Studies Program). HK reports honoraria for lectures from Eisai Co., Ltd., Nobelpharma Co., Ltd. Shiga prefecture, honoraria for manuscript writing from Nipponrinsyosya Co., Ltd., Life Science, and Asakura Publishing Co., Ltd., and consulting fees from Takeda Pharmaceutical Co., Ltd. Grants and personal fees from companies are not directly related to this study. The opinions expressed in this paper are those of the authors and do not necessarily represent those of companies including Merck Sharp and Dohme Corp/MSD K.K. The other authors declare no conflicts of interest.

Data sharing statement: The datasets analyzed in the current study are available from the corresponding author upon reasonable request at kadotanisleep@gmail.com.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Hiroshi Kadotani, MD, PhD, Professor, Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Shiga, Japan. kadotanisleep@gmail.com

Received: March 28, 2021
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

ARTICLE HIGHLIGHTS

Research background

Certain proportions of depressed patients relapse after electroconvulsive therapy (ECT), and it is important to explore ways to maintain remission.

Research motivation

Since 2001, when Sackeim reported on the addition of lithium to antidepressants for maintenance treatment after ECT, only symptomatic measures, such as continuation of continuation and/or maintenance ECT (C/M-ECT) have been proposed, and there have been no new findings leading to a fundamental solution for more than 20 years.

Research objectives

The objective of our study was to investigate the diagnostic factors and treatment strategies associated with the relapse of depression.

Research methods

We analyzed the relationships between relapse, the diagnostic change from major depressive disorder (MDD) to bipolar disorder (BP), and treatment strategies after the initial administration of ECT. We performed a 3-year retrospective cohort study on the prognosis of 85 patients at the Shiga University of Medical Science Hospital. The relative risk of relapse of depressive symptoms was calculated based on the diagnostic changes from MDD to BP. A receiver operating characteristic (ROC) curve was generated to evaluate the accuracy of predicting diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.

Research results

Compared with the MDD participants, a greater proportion of BP participants experienced relapse and required continuation and/or maintenance ECT for maintaining remission. The duration from the first course of ECT to relapse was shorter for the BP than the MDD patients.

Research conclusions

Instead of repeating treatment for MDD, such as C/M-ECT with antidepressants without definitive evidence of resolution, patients who relapse after ECT and maintenance with antidepressants may benefit from changing the maintenance treatment after remission with C/M-ECT to the treatment for BP depression, which includes mood stabilizers without antidepressants.

Research perspectives

It is also necessary to develop a method for predicting the occurrence of manic episodes to prevent the exacerbation of MDD, as well as overtreatment for maintaining the remission of severe MDD after initial ECT.