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Rehospitalization and suicide following electroconvulsive therapy for bipolar depression–A population-based register study

Journal article
Authors K. Popiolek
O. Brus
T. Elvin
Mikael Landén
J. Lundberg
P. Nordanskog
A. Nordenskjöld
Published in Journal of Affective Disorders
Volume 226
Pages 146-154
ISSN 0165-0327
Publication year 2018
Published at Institute of Neuroscience and Physiology
Pages 146-154
Language en
Keywords alimemazine, antidepressant agent, anxiolytic agent, benzodiazepine derivative, buspirone, central stimulant agent, hydroxyzine, lamotrigine, levomepromazine, lithium, mood stabilizer, neuroleptic agent, prometazine, quetiapine, unclassified drug, valproic acid, adolescent, adult, aged, Article, bipolar depression, bipolar disorder, cause of death, cohort analysis, combination drug therapy, controlled study, demography, electroconvulsive therapy, electroconvulsive therapy unit, electrode, female, follow up, hospital discharge, hospital readmission, human, maintenance therapy, major clinical study, male, mental patient, middle aged, observational study, polypharmacy, priority journal, prognosis, psychopharmacotherapy, register, risk factor, social status, suicide, suicide attempt, very elderly, young adult
Subject categories Neurology


Background Electroconvulsive therapy (ECT) is effective in bipolar depression, but relapse is common. The aim of the study was (i) to identify prognostic factors (ii) and to determine the impact of pharmacological approaches on the risk for rehospitalization or suicide. Methods This register study analyzed data from individuals treated with inpatient ECT for bipolar depression. Subjects were identified using the Swedish National Patient Register between 2011 and 2014 and the Swedish National Quality Register for ECT. Other national registers provided data on psychopharmacotherapy, socio-demographic factors, and causes of death. The endpoint was the composite of rehospitalization for any psychiatric disorder, suicide attempt or completed suicide (RoS). Cox regression was used to calculate hazard ratios in univariate and multivariate models. Results Data from 1255 patients were analyzed. The mean period of follow-up was 346 days. A total of 29%, 41%, and 52% of patients reached RoS at 3, 6, and 12 months post-discharge. A history of multiple psychiatric admissions, lower age, and post-discharge treatment with antipsychotics or benzodiazepines was associated with RoS. Limitations Indication bias may have affected the results. Conclusions A history of multiple hospital admissions and lower age are key predictors of the composite of rehospitalization or suicide in patients treated with ECT for bipolar depression. Lithium might be effective. By contrast, antipsychotics and benzodiazepines were associated with increased risk, but possibly this finding was influenced by indication bias. © 2017 The Authors

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Utskriftsdatum: 2019-12-13