Dynamics of Depressive and Psychomotor Symptoms During Electroconvulsive Therapy in Older Depressive Patients

Abstract

Objective Electroconvulsive therapy (ECT) is an effective treatment for patients experiencing a major depressive episode, especially older ones. Identification of specific responses within early ECT sessions remains an issue of debate, however. Hence, this pilot study prospectively examined the outcome in terms of depressive signs, symptom by symptom, throughout a course of ECT, concentrating particularly on psychomotor retardation symptoms. Methods Nine patients were clinically evaluated several times during the ECT course, before the first session and then weekly (over 3–6 weeks, according to their evolution), by completing the Montgomery-Åsberg Depression Rating Scale (MADRS), the Mini-Mental State Examination test, and the French Retardation Rating Scale for Depression for assessing the severity of psychomotor retardation. Results Nonparametric Friedman tests showed significant positive changes in mood disorders during ECT in older depressive patients (mean, −27.3% of initial MADRS total score). Fast improvement in French Retardation Rating Scale for Depression score was observed at t 1 (ie, after 3–4 ECT sessions), whereas a slightly delayed improvement in the MADRS scores was found at t 2 (ie, after 5–6 ECT sessions). Moreover, the scores for items linked to the motor component of psychomotor retardation (eg, gait, postural control, fatigability) were the first to significantly decrease during the first 2 weeks of the ECT course compared with the cognitive component. Conclusions Interestingly, participants' concentration on daily functional activities, their interest and fatigability, and their reported state of sadness were the first to progress, representing possible precursor signs of positive patient outcomes after ECT.