CARE-Dep: Clinical Predictors of Therapeutic Outcome in Electroconvulsive Therapy for Depression

Depression is a major public health challenge and a leading cause of disability worldwide. In Ireland, 6,000 people are hospitalised for depression each year. Although several effective treatment options are available, including brain stimulation techniques, antidepressant pharmacotherapy and psychotherapy, a third of people treated for depression do not respond to sequential trials of antidepressants. This state has been variously referred to as “treatment-resistant depression” or “difficult-to-treat depression” and is a topic of growing scientific and clinical interest.

While antidepressant medication is currently the mainstay of depression treatment, electroconvulsive therapy (ECT) remains the most effective treatment for depression. In Ireland and other Western countries, the majority of people referred for ECT have not responded to one or more adequate courses of antidepressant medication and can therefore be said to be treatment resistant. Despite this, over half of all people referred for ECT still go on to achieve a full remission. Nonetheless, some previous studies have found that medication resistance is associated with a diminished response to ECT. In addition to medication resistance, several other clinical predictors of ECT response have been identified in meta-analyses of previous research, including episode duration, older age and presence of psychotic features.

The purpose of the CARE-Dep study is to identify patient or illness characteristics that may predict a good therapeutic response to ECT. This could help us better predict in advance who is more likely to benefit from this treatment so that it can be delivered in a more optimised, personalised way.