Sex-specifics of ECT outcome.

OBJECTIVE: Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. METHODS: Clinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). RESULTS: Remission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. CONCLUSION: The evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex- specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not.

[Behavioural activation as a first-line treatment for depression]. / Gedragsactivatie als eerstelijnsbehandeling voor depressie.

Psychological treatments are important to reduce the global burden of depression; however, cognitive behavioural therapy (CBT), which is considered the gold-standard treatment, is costly and sparsely available. Behavioural activation (BA) is a psychological treatment aimed at overcoming depression by increasing positive activities, with the help of registration and activity scheduling. It is a simpler and less costly alternative to CBT, and is no less effective in the treatment of moderate to severe depression. Two-thirds of depressed patients can be effectively treated with BA, providing evidence for it being an important extension of the therapeutic arsenal for depression; this will quite probably be reflected by a more prominent place for this treatment in upcoming guidelines.