TY - JOUR
T1 - Precision ECT for major depressive disorder
T2 - A review of clinical factors, laboratory, and physiologic biomarkers as predictors of response and remission
AU - Yao, Zhixing
AU - McCall, William V.
AU - Essali, Norah
AU - Wohl, Ethan
AU - Parker, Carmen
AU - Rosenquist, Peter B.
AU - Youssef, Nagy Adel
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Predicting which patient(s) will respond to Electroconvulsive Therapy (ECT) has very important clinical implications. The aim of this manuscript is to review the current literature on clinical, physiologic and laboratory biomarkers as predictors of ECT response and remission related to the treatment of major depressive disorder (MDD). We will briefly discuss available research on the predictors of cognitive side effects of ECT. Although each clinical factor may have subtle influence on ECT response, taken together clinical predictors can lead to a robust treatment plan tailored for an individual patient, and advise on the likelihood of ECT response. Available literature supports the predictive value of several clinical factors. Older age, psychotic depression, and depression severity positively predict ECT response. Limited data is available for catatonia specific to MDD, but overall data shows positive response of ECT for the treatment of catatonia. Multiple medication trials in the current episode and comorbid psychiatric diagnosis (including borderline personality disorder and substance use disorder) predict lower response. Lack of widespread clinical availability and validation in larger studies limits current clinical utility of laboratory and physiologic biomarkers. Genetic, epigenetic, and proteomic factors have been investigated predominately in animal models, but ongoing research in human studies including neuroimaging is promising. Thus, these biomarkers provide an exciting outlook that may elevate the precision of ECT response and remission.
AB - Predicting which patient(s) will respond to Electroconvulsive Therapy (ECT) has very important clinical implications. The aim of this manuscript is to review the current literature on clinical, physiologic and laboratory biomarkers as predictors of ECT response and remission related to the treatment of major depressive disorder (MDD). We will briefly discuss available research on the predictors of cognitive side effects of ECT. Although each clinical factor may have subtle influence on ECT response, taken together clinical predictors can lead to a robust treatment plan tailored for an individual patient, and advise on the likelihood of ECT response. Available literature supports the predictive value of several clinical factors. Older age, psychotic depression, and depression severity positively predict ECT response. Limited data is available for catatonia specific to MDD, but overall data shows positive response of ECT for the treatment of catatonia. Multiple medication trials in the current episode and comorbid psychiatric diagnosis (including borderline personality disorder and substance use disorder) predict lower response. Lack of widespread clinical availability and validation in larger studies limits current clinical utility of laboratory and physiologic biomarkers. Genetic, epigenetic, and proteomic factors have been investigated predominately in animal models, but ongoing research in human studies including neuroimaging is promising. Thus, these biomarkers provide an exciting outlook that may elevate the precision of ECT response and remission.
KW - Depression
KW - ECT
KW - Major depressive disorder
KW - Precision ECT
KW - Predictors of remission
KW - Predictors of response
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U2 - 10.1016/j.pmip.2019.07.001
DO - 10.1016/j.pmip.2019.07.001
M3 - Review article
AN - SCOPUS:85113940073
SN - 2468-1717
VL - 17-18
SP - 23
EP - 31
JO - Personalized Medicine in Psychiatry
JF - Personalized Medicine in Psychiatry
ER -