One-year outcome of psychotic depression after successful electroconvulsive therapy

Background: Psychotic depression is thought to have a higher relapse frequency after electroconvulsive therapy (ECT) compared with nonpsychotic depression, although this observation is contradicted by previous studies that have found the opposite. In this study, the 1-year risk of relapse after successful ECT was determined prospectively in patients with psychotic depression and compared with the risk of relapse observed for depressed patients without psychotic features. Method: Fifty-nine responders to ECT (a decrease in Hamilton Rating Scale for Depression [HAM-D] score >= 50%) were followed for I year: 29 with and 30 without psychotic features. Relapse was defined as meeting DSM-IV criteria for major depressive disorder and a HAM-D score >= 16. The frequency of relapse after 4 and 12 months was compared between both samples, adjusted for the covariables duration of the index episode and type of post-ECT pharmacotherapy. Results: At both 4 and 12 months after ECT, instances of relapse were significantly lower in patients with psychotic depression compared with nonpsychotic patients: 3/28 (11%) versus 16/27 (59%) and 4/27 (15%) versus 19/28 (68%), respectively. Conclusions: The main finding of the present study is the favorable 1-year outcome for patients with psychotic depression after response to ECT with a trend toward the same result at 4 months. The 1-year outcome of the total sample is also more favorable than expected.