ECT response in delusional versus non-delusional depressed inpatients

Background: ECT is often considered more effective in delusional than in non-delusional depressives, although the literature does not support this view. Methods: We reviewed the records of 55 consecutive inpatients with major depression according to the DSM-III-R criteria and distinguished two subtypes: patients with delusions and those without. We examined whether the deluded patients showed a higher response rate. Results: using 50% reduction on the Hamilton Rating Scale for Depression (HRSD) as response criterion, the efficacy of ECT was higher in patients with delusional depression (92% response) than in the non-deluded patients (55% response). Considering a post-ECT HRSD score of ≤7 as response criterion, patients with delusions again showed a higher response rate (57% versus 24%). Limitations: this study has a retrospective nature and a rather homogenous sample. Conclusion: ECT appears to be an effective treatment for severely depressed inpatients, both with and without delusions. The efficacy of ECT was superior in patients with delusional depression, considering the number of patients achieving partial remission as well as full remission.