Long-term quality of life in treatment-resistant depression after electroconvulsive therapy

•We present QoL-data 6, 12, 18, 24 months after ECT.•Exploratory analyses showed that physical and psychological QoL were superior among subjects who were married, did not have disability status, had psychotic features, or had shorter index episodes at baseline.•A clinically meaningful improvement in physical and psychological QoL was observed in about 40–-50% of patients during follow-up. Electroconvulsive therapy (ECT) is highly effective for treatment-resistant depression (TRD), and previous studies have demonstrated short-term improvements in quality of life (QoL) after ECT. However, long-term QoL after ECT has not been studied, and the baseline patient characteristics that predict long-term QoL remain unknown. Seventy-nine subjects with unipolar or bipolar TRD were enrolled in this prospective longitudinal observational study. Physical, psychological, social, and environmental QoL domains were measured with the abbreviated World Health Organization Quality of Life scale (WHOQOL-BREF) at baseline and every 6 months for up to 2 years after ECT. Baseline sociodemographic and clinical features were tested for association with long-term QoL. Long-term follow-up data were available from 49 participants. Relative to baseline, average psychological and physical QoL improved during the follow-up period (Hedges' effect size: 0.27–0.83). About 40–50% of individuals experienced clinically meaningful improvement. Subjects with better initial antidepressant response with ECT reported better QoL over the subsequent two years. Long-term QoL improved most among individuals who were married, those without disability status, and those with psychotic features or shorter depressive episodes at baseline. Participants were from a single US academic center and mainly of European ancestry, so findings may not generalize to other settings or ethnicities. The observational design does not allow causal inferences. Long-term psychological and physical QoL outcomes vary widely after ECT. Individuals with the best outcomes are those who respond well to ECT initially, married people, and those with a less chronic course of illness.