Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
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
Abstract
BACKGROUND

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.

AIM

To investigate the diagnostic factors and treatment strategies associated with depression relapse.

METHODS

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.

RESULTS

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).

CONCLUSION

It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.

Keywords: Electroconvulsive therapy, Major depressive disorder, Bipolar disorder, Antidepressant, Prognosis, 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.