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
. 2024 Jul 1;7(7):e2422738.
doi: 10.1001/jamanetworkopen.2024.22738.

Seizure Duration and Electroconvulsive Therapy in Major Depressive Disorder

Cecilia Gillving  1 , Carl Johan Ekman  2   3 , Åsa Hammar  4   5 , Mikael Landén  6   7 , Johan Lundberg  2   3 , Pouya Movahed Rad  5 , Pia Nordanskog  8   9 , Lars von Knorring  10 , Axel Nordenskjöld  1
Affiliations

Seizure Duration and Electroconvulsive Therapy in Major Depressive Disorder

Cecilia Gillving et al. JAMA Netw Open. .

Abstract

Importance: Electroconvulsive therapy (ECT), wherein a generalized epileptic seizure is induced, is a treatment for major depressive disorder (MDD). Currently, it is unclear whether there is an association between seizure length and treatment outcome.

Objective: To explore the association between seizure duration, potential confounding variables, and ECT treatment outcome.

Design, setting, and participants: This population-based cohort study obtained data from the Swedish National Quality Register for ECT. Patients treated for unipolar MDD with unilateral electrode placement between January 1, 2012, and December 31, 2019, were included. The electroencephalographic (EEG) seizure duration from the first ECT treatment session for each patient was used for analysis. Data analyses were performed between March 2021 and May 2024.

Main outcomes and measures: The primary outcome was remission, defined as a cutoff score of less than 10 points on the self-assessment version of the Montgomery-Åsberg Depression Rating Scale within 1 week after ECT. Multivariate logistic regression analysis was performed to calculate odds ratios (ORs) between different seizure duration groups. Furthermore, the associations between concomitant use of pharmacological treatments, seizure duration, and remission rate were explored.

Results: Among the 6998 patients included, 4229 (60.4%) were female and the mean (SD) age was 55.2 (18.6) years. Overall, 2749 patients (39.3%) achieved remission after ECT. Patients with EEG seizure duration of 60 to 69 seconds had the highest remission rates compared with patients with seizure duration of less than 20 seconds (OR, 2.17; 95% CI, 1.63-2.88; P < .001). Anticonvulsant medications were associated with shorter seizure duration (eg, lamotrigine: β coefficient [SE], -6.02 [1.08]; P < .001) and lower remission rates (eg, lamotrigine: adjusted OR, 0.67; 95% CI, 0.53-0.84; P < .001).

Conclusions and relevance: This study found an association between seizure length and remission from MDD. Use of anticonvulsant medication during ECT was associated with shorter seizure duration and lower remission rates after ECT.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Landén reported receiving grants from the Swedish Research Council, Swedish Brain Foundation, and Swedish government under the ALF agreement during the conduct of the study and receiving personal fees from Lundbeck Pharmaceuticals outside the submitted work. Dr Lundberg reported receiving personal fees from Jansen-Cilag and grants from the Osmond Foundation outside the submitted work. Dr Movahed Rad reported receiving personal fees from Lundbeck Pharmaceuticals outside the submitted work. Dr Nordenskjöld reported receiving grants from Nyckelfonden at Örebro University Hospital and Region Örebro County ALF during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Remission as a Variable Dependent on Electroencephalographic (EEG) Seizure Duration
Error bars represent 95% CIs. AOR indicates adjusted odds ratio.
See this image and copyright information in PMC

Comment in

References

    1. Espinoza RT, Kellner CH. Electroconvulsive therapy. N Engl J Med. 2022;386(7):667-672. doi:10.1056/NEJMra2034954 - DOI - PubMed
    1. Anand A, Mathew SJ, Sanacora G, et al. . Ketamine versus ECT for nonpsychotic treatment-resistant major depression. N Engl J Med. 2023;388(25):2315-2325. doi:10.1056/NEJMoa2302399 - DOI - PubMed
    1. Movahed P, Nordenskjöld A, Kellner CH. Ketamine versus ECT for nonpsychotic treatment-resistant major depression. N Engl J Med. 2023;389(10):960-961. doi:10.1056/NEJMc2308757 - DOI - PubMed
    1. Fink M. What is an adequate treatment in convulsive therapy? Acta Psychiatr Scand. 1991;84(5):424-427. doi:10.1111/j.1600-0447.1991.tb03172.x - DOI - PubMed
    1. Task Force on Electroconvulsive Therapy, American Psychiatric Association . The practice of ECT: recommendations for treatment, training and privileging. Convuls Ther. 1990;6(2):85-120. - PubMed

Publication types