Differential Factor-Level MADRS Response Associated With Seizure Duration in Electroconvulsive Therapy

BACKGROUND: Electroconvulsive therapy (ECT) is a widely used treatment for severe and treatment-resistant depression, with high efficacy but considerable interindividual variability of response. The neurophysiological mechanisms underlying ECT's antidepressant effects, particularly the role of seizure duration, remain unclear. This exploratory study investigates how EEG-measured seizure duration influences depressive symptomatology. METHODS: We retrospectively analyzed data from 53 participants with depressive symptoms (MADRS ≥21) who underwent ECT at the interventional psychiatry unit of the Lausanne University Hospital (CHUV) between November 2023 and April 2025. MADRS scores were assessed at baseline and 6 weeks after ECT. Seizure duration was categorized into 3 groups: short (25 to 39 s), medium (40 to 59 s), and long (≥60 s). Statistical tests, including the Kruskal-Wallis and multiple linear regression, were performed to assess the differences in MADRS score changes across these groups. In addition, we conducted exploratory analyses at the symptom cluster level in MADRS score changes. RESULTS: Participants in the medium seizure duration group (40 to 59 s) exhibited the greatest overall improvement in MADRS scores, including a significant reduction in the anxiety and vegetative symptoms cluster. In contrast, for affective and anhedonic symptoms and hopelessness symptoms, the difference between the seizure duration categories did not reach statistical significance. CONCLUSION: This study identifies an optimal seizure duration window (40 to 59 s) as most effective in reducing symptom severity, as measured by MADRS and its symptom cluster factors. Further research is needed to better understand the complex relationship between seizure dynamics and ECT outcomes.