TY - JOUR
AU - K. J. Li
AU - N. E. Slama
AU - I. L. Chen
AU - S. Ridout
AU - E. Iturralde
A1 - 
AB - Interventional psychiatric procedures (IPPs) such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine intravenous treatments (KIT) are widely used for treatment resistant depression (TRD), but we lack studies of their real-world impact compared to standard outpatient medication management (MM). Longitudinal electronic health records of 22,481 patients in a large integrated healthcare system during 2018-2022 were examined to describe depression improvement via 9-item Patient Health Questionnaire (PHQ-9), changes in psychiatric admissions, and use of continuation/maintenance (C/M) treatments. Overall, each IPP group had significantly greater depression improvement at 6 weeks compared to MM: adjusted estimates TMS:1.64 (p < 0.001), KIT:2.02 (p < 0.001), and ECT:2.16 (p < 0.001). Patient characteristics were associated with symptom worsening within treatment groups, for example: (1) non-white race for ECT (2.33, p < 0.01) and MM (0.29, p < 0.001); (2) anxiety disorder for TMS (1.73, p < 0.001); and (3) personality disorder for all treatment groups, with significant coefficients found for KIT (3.27, p < 0.05) and MM (1.27, p < 0.001). Some examples of correlations with improved symptom response include: (1) psychotic disorder for ECT (-3.57, p < 0.01); and (2) bipolar disorder for KIT (-2.19; p < 0.05). For the KIT group, C/M treatment versus no C/M treatment was associated with lower risk for 12-month psychiatric hospitalization (adjusted relative risk: 0.25). This is the first study to show a protective association for maintenance ketamine on psychiatric hospitalization risk. Treatment-specific predictors of response should be confirmed in future comparative effectiveness studies.
AD - The Permanente Medical Group, 3600 Broadway, Oakland, CA 94611, USA; University of California San Francisco, 1701 Divisadero St, San Francisco, CA 94115, USA. Electronic address: Kevin.j.li@kp.org.; Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Pleasanton, CA 94588, USA. Electronic address: natalie.slama@kp.org.; The Permanente Medical Group, 3600 Broadway, Oakland, CA 94611, USA. Electronic address: ingrid.l.chen@kp.org.; The Permanente Medical Group, 3600 Broadway, Oakland, CA 94611, USA. Electronic address: Samuel.ridout@kp.org.; University of California San Francisco, 1701 Divisadero St, San Francisco, CA 94115, USA; Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Pleasanton, CA 94588, USA. Electronic address: estabaliz.m.iturralde@kp.org.
AN - 40716263
BT - Psychiatry Res
C5 - HIT & Telehealth
DA - Sep
DO - 10.1016/j.psychres.2025.116647
DP - NLM
ET - 20250719
JF - Psychiatry Res
LA - eng
N2 - Interventional psychiatric procedures (IPPs) such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine intravenous treatments (KIT) are widely used for treatment resistant depression (TRD), but we lack studies of their real-world impact compared to standard outpatient medication management (MM). Longitudinal electronic health records of 22,481 patients in a large integrated healthcare system during 2018-2022 were examined to describe depression improvement via 9-item Patient Health Questionnaire (PHQ-9), changes in psychiatric admissions, and use of continuation/maintenance (C/M) treatments. Overall, each IPP group had significantly greater depression improvement at 6 weeks compared to MM: adjusted estimates TMS:1.64 (p < 0.001), KIT:2.02 (p < 0.001), and ECT:2.16 (p < 0.001). Patient characteristics were associated with symptom worsening within treatment groups, for example: (1) non-white race for ECT (2.33, p < 0.01) and MM (0.29, p < 0.001); (2) anxiety disorder for TMS (1.73, p < 0.001); and (3) personality disorder for all treatment groups, with significant coefficients found for KIT (3.27, p < 0.05) and MM (1.27, p < 0.001). Some examples of correlations with improved symptom response include: (1) psychotic disorder for ECT (-3.57, p < 0.01); and (2) bipolar disorder for KIT (-2.19; p < 0.05). For the KIT group, C/M treatment versus no C/M treatment was associated with lower risk for 12-month psychiatric hospitalization (adjusted relative risk: 0.25). This is the first study to show a protective association for maintenance ketamine on psychiatric hospitalization risk. Treatment-specific predictors of response should be confirmed in future comparative effectiveness studies.
PY - 2025
SN - 0165-1781 (Print); 0165-1781
SP - 116647
ST - Outcomes of patients receiving interventional psychiatric procedures in a large integrated healthcare system
T1 - Outcomes of patients receiving interventional psychiatric procedures in a large integrated healthcare system
T2 - Psychiatry Res
TI - Outcomes of patients receiving interventional psychiatric procedures in a large integrated healthcare system
U1 - HIT & Telehealth
U3 - 10.1016/j.psychres.2025.116647
VL - 351
VO - 0165-1781 (Print); 0165-1781
Y1 - 2025
ER -