The efficacy of acute electroconvulsive therapy in atypical depression

Mustafa M. Husain, Shawn M. McClintock, A. John Rush, Rebecca G. Knapp, Max Fink, Teresa A. Rummans, Keith Rasmussen, Cynthia Claassen, Georgios Petrides, Melanie M. Biggs, Martina Mueller, Shirlene Sampson, Samuel H. Bailine, Sarah H. Lisanby, Charles H. Kellner

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Objective: This study examined the characteristics and outcomes of patients with major depressive disorder (MDD), with or without atypical features, who were treated with acute bilateral electroconvulsive therapy (ECT). Method: Analyses were conducted with 489 patients who met DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the basis of the Structured Clinical Interview for DSM-IV obtained at baseline prior to ECT. Depression symptom severity was measured by the 24-item Hamilton Rating Scale for Depression (HAM-D24) and the 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR30). Remission was defined as at least a 60% decrease from baseline in HAM-D24 score and a total score of 10 or below on the last 2 consecutive HAM-D24 ratings. The randomized controlled trial was performed from 1997 to 2004. Results: The typical (N = 453) and atypical (N = 36) groups differed in several sociodemographic and clinical variables including gender (p = .0071), age (p = .0005), treatment resistance (p = .0014), and age at first illness onset (p < .0001) and onset of current episode (p = .0008). Following an acute course of bilateral ECT, a considerable portion of both the typical (67.1%) and the atypical (80.6%) groups reached remission. The atypical group was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group after adjustment for age, psychosis, gender, clinical site, and depression severity based on the HAM-D24. Conclusion: Acute ECT is an efficacious treatment for depressed patients with typical or atypical symptom features. Trial Registration: Identifier: NCT00000375.

Original languageEnglish (US)
Pages (from-to)406-411
Number of pages6
JournalJournal of Clinical Psychiatry
Issue number3
StatePublished - Mar 2008

ASJC Scopus subject areas

  • Psychiatry and Mental health


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