La terapia elettroconvulsivante nella depressione resistente: Una casistica di 25 pazienti

Objectives: The electroconvulsive therapy (ECT) is a non-pharmacological somatic treatment whose effectiveness has been demonstrated for patients suffering from severe and resistant depression (i.e. cases in which patients do not respond adequately to antide-pressant treatment). It is estimated that Treatment Resistant Depression occurs in up to 30% to 40% of depressive episodes adequately treated with first-line antidepressant therapy in psychiatric setting. Treatment Resistant Depression results in disproportionate burdens, escalating medical and mental health care costs, clinicians time, and personal suffering. Several studies demonstrated ECT's efficacy in different subgroups, such as patients with bipolar depression, mixed state, psychotic features and suicidal ideation. Methods: We report a case series of 25 patients with treatment-resistant major depression who received ECT at the psychiatric unit of Casa di Cura "Villa Serena", Città Sant'Angelo. The subjects included in the study had at least 18 years of age and met the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), for a major depressive episode associated with major depressive disorder (MDD) (n = 11, 44%), bipolar disorder (BP) (n = 11, 44%) and schizoaffective disorder (n = 3, 12%). The group consisted of 8 men and 17 women with a mean age ± SD of 53.72 ± 13.88 years and with a mean age of onset of 32.12 ± 14.16 years. 9 patients (36%) had a temperament hyperthymic, 7 (28%) depressive, and 9 (36%) anxious. 11 patients (44%) had a history of suicidal behavior. Patients have been evaluated before treatment, one week, 6 months and 1 year after the treatment with a global clinical assessment (CGI). Results: Clinical evaluations made a week after the ECT showed a clinical improvement overall in 10 patients (90%) with a diagnosis of depressive disorder, 7 (63%) with bipolar disorder and 3 (100%) with schizoaffective disorder. The same evaluation repeated 6 months and 1 year after the ECT reaffirmed a global clinical improvement in 8 patients (72%) with a diagnosis of depressive disorder, 6 (54%) with bipolar disorder and in 1 subject (33%) diagnosed with schizoaffective disorder. Conclusions: Electroconvulsive therapy appears to be effective in determining the overall clinical improvement in treated subjects. All subjects with depressive temperament show an improvement in global clinical assessments at all the three post-treatment evaluations. In particular, in our sample there were no differences in outcome due to diagnostic subgroup belonging, to presence or absence of suicidality and to temperamental characteristics. These conclusions are, however, limited by the experimental design and therefore liable to many uncontrolled variables.