Baseline suicidal thoughts are associated with ECT non-remission and cognitive side effects: A network outcome analysis.

Authors

Melissa G Zandstra, Metten Somers, Milou Angevaare, Tom Birkenhager, Birit F P Broekman, Rieky Dikmans, Philip van Eijndhoven, Milou A van Eldik, Eric van Exel, Frank L Gerritse, Johanna M Hegeman, Willemijn Heijnen, Rob M Kok, Dore Loef, Roel J T Mocking, Jasper O Nuninga, Mardien L Oudega, Didi Rhebergen, Jordy Rovers, Bart P F Rutten, Bart Schut, Iris E Sommer, Indira Tendolkar, Esmée Verwijk, Hanneke van Welie, Annemiek Dols, Floortje E Scheepers, Edwin van Dellen

Published in

Journal of affective disorders. Pages 122749. Nov 14, 2026. Epub Nov 14, 2026.

Abstract

Electroconvulsive therapy (ECT) is effective for severe depression, yet remission is not universal and cognitive side effects remain a concern. Individual depressive symptoms may provide prognostic information beyond overall severity scores.
In a multicentre cohort from the Dutch ECT Consortium, we applied network outcome analysis to seven symptoms harmonized across the Hamilton Depression Rating Scale and Montgomery-Åsberg Depression Rating Scale (MADRS). Outcomes were remission (N = 792) and in exploratory analysis, cognitive side effects (N = 100). Robustness was assessed through bootstrapping and sensitivity analyses, including established clinical predictors, an alternative remission definition, and multivariable logistic regression.
Suicidal thoughts were associated with lower odds of remission (OR 0.77, bootstrapped confidence interval [bCI] 0.68-0.84) and higher odds of cognitive side effects (OR 1.34, bCI 1.15-2.02), with 98-100% and 72-91% bootstrap edge presence across sensitivity analyses, respectively. Reduced appetite was associated with higher remission odds (OR 1.08, bCI 1.03-1.22), with 70-94% bootstrap edge presence across sensitivity analyses, but the association was absent in the MADRS-specific analysis. Tension/anxiety was associated with higher odds of cognitive side effects (OR 1.26, bCI 1.14-1.92), with 77-84% bootstrap edge presence. After simultaneous covariate adjustment, logistic regression supported associations of suicidal thoughts with both outcomes and tension/anxiety with cognitive side effects; the adjusted cognitive model was exploratory.
Baseline symptoms showed distinct associations with ECT outcomes. Suicidal thoughts were associated with both lower remission likelihood and higher odds of cognitive side effects, suggesting potential relevance for clinical monitoring and counselling.

PMID:
43033988
Bibliographic data and abstract were imported from PubMed on 15 Nov 2026.

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