Improvement after two sessions of electroconvulsive therapy predicts final remission in in‐patients with major depression

OBJECTIVE: To investigate whether early improvement, measured after two electroconvulsive therapy (ECT) sessions, is a good predictor of eventual remission in severely depressed in‐patients receiving ECT. METHOD: A prospective cohort study was performed that included 89 major depressive disorder in‐patients treated with bilateral ECT. Sensitivity, specificity, and predictive values were computed for various definitions of early improvement (15%, 20%, 25%, and 30% reduction on the Montgomery Asberg depression rating scale (MADRS) score) after 1 week (i.e. two sessions) of ECT regarding prediction of remission (final MADRS score ≤ 9). RESULTS: A 15% reduction in MADRS score appeared to be the best definition of early improvement, with modest sensitivity (51%) and relatively good specificity (79%). Kaplan–Meier analysis showed a more than 2‐week shorter time to remission in patients with early improvement compared with patients lacking early improvement. CONCLUSION: Early improvement during an ECT course may be assessed after two ECT sessions. Such improvement, defined as a 15% reduction in the MADRS score, is a moderately sensitive predictor for eventual remission in an in‐patient population with severe major depression.