{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T19:35:43Z","timestamp":1780342543202,"version":"3.54.1"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Major depressive disorder (MDD) is a common psychiatric disorder. Despite several treatment options, a subgroup of patients will not respond to the commonly used antidepressant treatments and thus express treatment resistance (TRD). TRD can be quantified with the Dutch Measure for Treatment Resistance in Depression (DM\u2010TRD). Electroconvulsive therapy (ECT) is an effective treatment for MDD, also in TRD. Yet, the position of ECT as \u201ctreatment\u2010of\u2010last\u2010resort\u201d may decrease the likelihood of beneficial outcome. Our aim was to investigate the association between treatment resistance and outcome and course of ECT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective, multicenter cohort study with 440 patients of which data was retrieved from patient records as collected in the Dutch ECT Cohort database. Linear and logistic regression models were used to explore the association between level of treatment resistance and outcome of ECT. Median split was used to explore the differences between high and low level of TRD and course of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A higher DM\u2010TRD score was associated with significantly smaller reduction of depression symptoms (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.160;\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22122.968;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and lower chance of response (OR\u2009=\u20090.821 [95 CI: 0.760\u20130.888];\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.197;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Low level TRD patients underwent fewer ECT sessions (mean 13\u2009\u00b1\u20096 SD vs. 16\u2009\u00b1\u20097 SD;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and fewer switches from right unilateral tot bifrontotemporal electrode placement (29% vs. 40%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reserving ECT as \u201ctreatment\u2010of\u2010last\u2010resort\u201d in the treatment algorithm for MDD seems questionable, because in our study lower level of treatment resistance predicted more beneficial ECT\u2010outcome. Moreover, providing ECT in less treatment resistant patients showed fewer needed ECT\u2010sessions and less switches to BL electrode placement, which may decrease the risk for cognitive side\u2010effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.13550","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T11:56:59Z","timestamp":1680177419000},"page":"570-580","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The impact of treatment resistance on outcome and course of electroconvulsive therapy in major depressive disorder"],"prefix":"10.1111","volume":"147","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4636-9412","authenticated-orcid":false,"given":"J. J. E.","family":"Rovers","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen  Nijmegen The Netherlands"},{"name":"Department of Psychiatry Canisius\u2010Wilhelmina Hospital  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Vissers","sequence":"additional","affiliation":[{"name":"GGZ Breburg  Tilburg The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Loef","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Amsterdam UMC, Location Vrije Universiteit Amsterdam  Boelelaan 1117 Amsterdam The Netherlands"},{"name":"Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep &amp; Stress Program  Amsterdam The Netherlands"},{"name":"GGZ inGeest Mental Health Care  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. A.","family":"van Waarde","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Rijnstate Depression Center  Arnhem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. P. A. J.","family":"Verdijk","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Rijnstate Depression Center  Arnhem The Netherlands"},{"name":"Department of Clinical Neurophysiology University of Twente  Enschede The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. F. P.","family":"Broekman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Amsterdam UMC, Location Vrije Universiteit Amsterdam  Boelelaan 1117 Amsterdam The Netherlands"},{"name":"Department of Psychiatry and Medical Psychology OLVG Hospital  P.O. Box 95500 1090 HM Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. C. M.","family":"Vergouwen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Medical Psychology OLVG Hospital  P.O. Box 95500 1090 HM Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. L.","family":"Oudega","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Amsterdam UMC, Location Vrije Universiteit Amsterdam  Boelelaan 1117 Amsterdam The Netherlands"},{"name":"GGZ inGeest Mental Health Care  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"van Exel","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Amsterdam UMC, Location Vrije Universiteit Amsterdam  Boelelaan 1117 Amsterdam The Netherlands"},{"name":"GGZ inGeest Mental Health Care  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Coenen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. S.","family":"Everaerd","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Tendolkar","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Dols","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Amsterdam UMC, Location Vrije Universiteit Amsterdam  Boelelaan 1117 Amsterdam The Netherlands"},{"name":"Department of Psychiatry, UMC Utrecht Brain Center University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. F. P.","family":"van Eijndhoven","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2017.4602"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.6.593"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0706743716664885"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2016.2586"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2005.00602.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13091"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12959"},{"key":"e_1_2_11_9_1","first-page":"82","article-title":"The prevalence and national burden of treatment\u2010resistant depression and major depressive disorder in the United States","volume":"16","author":"Zhdanava M","year":"2021","journal-title":"J Clin Psychiatry"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.08m04309"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2011.02.020"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/da.22865"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.08.019"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.08m04728"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2012.00997.x"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2004.05.006"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12705-5"},{"key":"e_1_2_11_18_1","unstructured":"APA.Practice Guideline For The Treatment of Patients With Major Depressive Disorder; 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