Abstract
Electroconvulsive therapy (ECT) is the most effective therapy for severe depressive disorders. Though there are known clinical predictors of response (e.g., higher age, presence of psychotic symptoms), there is a lack of knowledge concerning the impact of patients’ expectations on treatment outcome and tolerability in terms of possible placebo/nocebo effects. In 31 patients with unipolar or bipolar depressive disorder, we used a questionnaire to investigate the patients’ expectations of ECT effectiveness and tolerability prior to and in the course of the treatment. Additionally, the questionnaire was used after the ECT course for a final assessment. Depressive symptoms and putative side-effects were measured at each time point. General linear models were used to analyze the course of depressive symptoms and patients’ expectation of ECT effectiveness and tolerability. ECT significantly reduced depressive symptoms with large effect sizes. Patients’ rating of ECT effectiveness decreased in parallel: While responders’ rating of ECT effectiveness remained stable on a high level, non-responders’ rating decreased significantly. Group difference was significant after, but not prior to and during the treatment. Regarding tolerability, there was a (temporary) significant increase in the severity of self-rated symptoms such as headache and memory impairment. In contrast, patients’ expectation and assessment of ECT tolerability remained unchanged, and their expectations prior to ECT had no impact on the occurrence of side-effects. These findings contradict the presence of relevant placebo/nocebo effects in the context of ECT when investigating a population of mostly chronic or treatment resistant patients with moderate to severe depressive disorder.
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References
UK ECT Review Group (2003) Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 361(9360):799–808. doi:10.1016/S0140-6736(03)12705-5
Rhebergen D, Huisman A, Bouckaert F et al (2015) Older age is associated with rapid remission of depression after electroconvulsive therapy: a latent class growth analysis. Am J Geriatr Psychiatry 23(3):274–282. doi:10.1016/j.jagp.2014.05.002
Dombrovski AY, Mulsant BH, Haskett RF et al (2005) Predictors of remission after electroconvulsive therapy in unipolar major depression. J Clin Psychiatry 66(8):1043–1049
Nordenskjold A, von Knorring L, Engstrom I (2012) Predictors of the short-term responder rate of Electroconvulsive therapy in depressive disorders—a population based study. BMC Psychiatry 12:115. doi:10.1186/1471-244X-12-115
Kho KH, Zwinderman AH, Blansjaar BA (2005) Predictors for the efficacy of electroconvulsive therapy: chart review of a naturalistic study. J Clin Psychiatry 66(7):894–899
Rasmussen KG (2009) Sham electroconvulsive therapy studies in depressive illness: a review of the literature and consideration of the placebo phenomenon in electroconvulsive therapy practice. J ECT 25(1):54–59. doi:10.1097/YCT.0b013e3181719b23
Chakrabarti S, Grover S, Rajagopal R (2010) Electroconvulsive therapy: a review of knowledge, experience and attitudes of patients concerning the treatment. World J Biol Psychiatry 11(3):525–537. doi:10.3109/15622970903559925
Rush G, McCarron S, Lucey JV (2007) Patient attitudes to electroconvulsive therapy. Psychiatr Bull 31(6):212–214. doi:10.1192/pb.bp.106.011486
Rose D, Fleischmann P, Wykes T et al (2003) Patients’ perspectives on electroconvulsive therapy: systematic review. BMJ 326(7403):1363. doi:10.1136/bmj.326.7403.1363
Brodaty H, Berle D, Hickie I et al (2003) Perceptions of outcome from electroconvulsive therapy by depressed patients and psychiatrists. Aust NZ J Psychiatry 37(2):196–199. doi:10.1046/j.1440-1614.2003.01129.x
Husain MM, Rush AJ, Fink M et al (2004) Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report. J Clin Psychiatry 65(4):485–491
Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134(4):382–389
Schmidtke A, Fleckenstein P, Moises W et al (1988) Studies of the reliability and validity of the German version of the Montgomery-Asberg Depression Rating Scale (MADRS). Schweiz Arch Neurol Psychiatr (1985) 139(2):51–65
Gomez J (1975) Subjective side-effects of ECT. Br J Psychiatry 127(6):609–611. doi:10.1192/bjp.127.6.609
Benbow SM (2004) Subjective experience of electroconvulsive therapy. Psychiatr Bull 28(8):289–291. doi:10.1192/pb.28.8.289
Beck AT, Steer RA, Brown GK (2009) Beck-Depression-Inventory (BDI-II): Frankfurt. Pearson Assessment, Germany
Kuhner C, Burger C, Keller F et al (2007) Reliability and validity of the Revised Beck Depression Inventory (BDI-II). Results from German samples (Reliabilitat und Validitat des revidierten Beck-Depressions inventars (BDI-II). Befunde aus deutschsprachigen Stichproben). Nervenarzt 78(6):651–656. doi:10.1007/s00115-006-2098-7
Iacobucci D, Posavac SS, Kardes FR et al (2015) The median split: robust, refined, and revived. J Consum Psychol 25(4):690–704. doi:10.1016/j.jcps.2015.06.014
Nitturkar AR, Sinha P, Bagewadi VI et al (2016) Effect of age and anticonvulsants on seizure threshold during bilateral electroconvulsive therapy with brief-pulse stimulus: a chart-based analysis. Indian J Psychiatry 58(2):190–197. doi:10.4103/0019-5545.183792
Rief W, Anna Glombiewski J (2017) The role of expectations in mental disorders and their treatment. World Psychiatry 16(2):210–211. doi:10.1002/wps.20427
Schedlowski M, Enck P, Rief W et al (2015) Neuro-bio-behavioral mechanisms of placebo and nocebo responses: implications for clinical trials and clinical practice. Pharmacol Rev 67(3):697–730. doi:10.1124/pr.114.009423
Weimer K, Colloca L, Enck P (2015) Placebo effects in psychiatry: mediators and moderators. Lancet Psychiatry 2(3):246–257. doi:10.1016/S2215-0366(14)00092-3
Methfessel I, Sartorius A, Zilles D (2017) Electroconvulsive therapy against the patients’ will: a case series. World J Biol Psychiatry. doi:10.1080/15622975.2017.1293296
Besse M, Methfessel I, Wiltfang J et al (2017) Electroconvulsive therapy in nonconsenting patients. Nervenarzt 88(1):46–52. doi:10.1007/s00115-015-0043-3
Semkovska M, McLoughlin DM (2010) Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry 68:568–577
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This study has been approved by the local ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Krech, L., Belz, M., Besse, M. et al. Influence of depressed patients’ expectations prior to electroconvulsive therapy on its effectiveness and tolerability (Exp-ECT): a prospective study. Eur Arch Psychiatry Clin Neurosci 268, 809–817 (2018). https://doi.org/10.1007/s00406-017-0840-8
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DOI: https://doi.org/10.1007/s00406-017-0840-8