Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Jan;149(1):18-32.
doi: 10.1111/acps.13631. Epub 2023 Oct 29.

Outcomes of electroconvulsive therapy in patients with depressive symptoms with versus without comorbid personality disorders/traits: A systematic review and meta-analysis

Stefano Ferrea  1 , Georgios Petrides  2   3   4 , Yamina Ehrt-Schäfer  1 , Jules Angst  1 , Erich Seifritz  1 , Sebastian Olbrich  1 , Georgios Schoretsanitis  1   2   3
Affiliations
Meta-Analysis

Outcomes of electroconvulsive therapy in patients with depressive symptoms with versus without comorbid personality disorders/traits: A systematic review and meta-analysis

Stefano Ferrea et al. Acta Psychiatr Scand. 2024 Jan.

Abstract

Aims: To assess electroconvulsive therapy (ECT) outcomes in patients affected by depressive symptoms with versus without additional comorbid personality disorders/traits.

Methods: We identified observational studies investigating ECT clinical outcomes in patients affected by depressive symptoms with versus without comorbid personality disorders/traits in Embase/Medline in 11/2022. Our protocol was registered with PROSPERO (CRD42023390833). Study quality was evaluated using the Newcastle-Ottawa-Scale. Our primary outcomes were ECT response and remission rates. Meta-regression analyses included effects of in/outpatient percentages, age, number of ECT sessions, and electrode placement; subgroup analyses included the assessment methods for personality disorders/traits. We performed sensitivity analyses after excluding poor-quality studies.

Results: A total of 20 studies (n = 11,390) were included in our analysis. Patients with comorbid personality disorders/traits had lower remission rates (OR = 0.42, 95% CI = 0.31, 0.58, p < 0.001) with substantial heterogeneity (I2 = 93.0%) as well as lower response rates (OR = 0.35, 95% CI = 0.24, 0.51, n = 5129, p < 0.001) with substantial heterogeneity (I2 = 93.0%) compared with patients without comorbid personality disorders/traits. Relapse rates were higher in patients with versus without comorbid personality disorders/traits (OR = 3.23, 95% CI = 1.40, 7.45, k = 4, n = 239, p = 0.006) with moderate heterogeneity (I2 = 75.0%) and post-ECT memory impairment was more frequent in patients with versus without comorbid personality disorders/traits (OR = 1.41, 95% CI = 1.36, 1.46, k = 4, n = 471, p < 0.001) with minimal heterogeneity (I2 = 0.0%). Dropout rates were higher in patients with versus without comorbid personality disorders/traits (OR = 1.58, 95% CI = 1.13, 2.21, k = 3, n = 6145, p = 0.008).

Conclusions: Patients with comorbid personality disorders/traits treated with ECT are reported to have lower response and remission rates and higher rates of side effects and relapse rates compared with patients without personality disorders/traits.

Keywords: ECT; electroconvulsive therapy; major depressive disorders; mood disorders; personality disorders; personality traits.

PubMed Disclaimer

References

REFERENCES

    1. De Carlo V, Calati R, Serretti A. Socio‐demographic and clinical predictors of non‐response/non‐remission in treatment resistant depressed patients: a systematic review. Psychiatry Res. 2016;240:421‐430. doi:10.1016/j.psychres.2016.04.034
    1. Nicolini AP, Sienaert P. Borderline personality disorder and outcome of electroconvulsive therapy in patients with depression: a systematic review. J ECT. 2023;39(2):74‐80. doi:10.1097/YCT.0000000000000900
    1. Rasmussen KG, Lineberry TW. Patients who inappropriately demand electroconvulsive therapy. J ECT. 2007;23(2):109‐113. doi:10.1097/yct.0b013e318048a1b8
    1. de Vreede IM, Burger H, van Vliet IM. Prediction of response to ECT with routinely collected data in major depression. J Affect Disord. 2005;86(2–3):323‐327. doi:10.1016/j.jad.2005.03.008
    1. Nordenskjöld A, von Knorring L, Engström I. Predictors of the short‐term responder rate of electroconvulsive therapy in depressive disorders—a population based study. BMC Psychiatry. 2012;12:115. doi:10.1186/1471‐244X‐12‐115

LinkOut - more resources