Impact of sex differences on the association between clinical predictors and electroconvulsive therapy outcomes: results from the Dutch ECT Consortium (DEC)

Machteld A J T Blanken; Mardien L Oudega; Dore Loef; Patrick F A Tuijp; E van Exel; Metten Somers; Edwin van Dellen; Roel J T Mocking; Dominika Karaszewska; Anouk E de Wit; Johanna M Hegeman; Karen van den Berg; Didi Rhebergen; Bart P F Rutten; Birit F P Broekman; Anton C M Vergouwen; Thomas J C Zoon; Rob M Kok; Karina Somers; Esmée Verwijk; Jordy J E Rovers; Gijsbert Schuur; Jeroen A van Waarde; Joey P A J Verdijk; Dieneke Bloemkolk; Frank L Gerritse; Hanneke van Welie; Bartholomeus C M Haarman; Sjoerd M van Belkum; Maurice Vischjager; Tom K Birkenhager; Willemijn Heijnen; Indira Tendolar; Philip F P van Eijndhoven; Annemiek Dols

doi:10.1016/j.jad.2026.122117

Impact of sex differences on the association between clinical predictors and electroconvulsive therapy outcomes: results from the Dutch ECT Consortium (DEC)

Machteld A J T Blanken^*
, Mardien L Oudega
, Dore Loef
, Patrick F A Tuijp
, E van Exel
, Metten Somers
, Edwin van Dellen
, Roel J T Mocking
, Dominika Karaszewska
, Anouk E de Wit
, Johanna M Hegeman
, Karen van den Berg
, Didi Rhebergen
, Bart P F Rutten
, Birit F P Broekman
, Anton C M Vergouwen
, Thomas J C Zoon
, Rob M Kok
, Karina Somers
, Esmée Verwijk

Jordy J E Rovers, Gijsbert Schuur, Jeroen A van Waarde, Joey P A J Verdijk, Dieneke Bloemkolk, Frank L Gerritse, Hanneke van Welie, Bartholomeus C M Haarman, Sjoerd M van Belkum, Maurice Vischjager, Tom K Birkenhager, Willemijn Heijnen, Indira Tendolar, Philip F P van Eijndhoven, Annemiek Dols

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVE: Medical research historically underrepresented women, often generalizing findings from men to women. Sex-specific analyses could enhance guideline accuracy and support personalized care. Electroconvulsive therapy (ECT) is highly effective in major depressive disorder (MDD), however research regarding the impact of sex on ECT efficacy is scarce. This study aimed to explore sex differences in ECT outcome and clinical variables associated with ECT outcome to replicate and extend previous research.

METHODS: Clinical data from sites participating in the Dutch ECT Consortium. Remission was defined as a post-ECT Hamilton Depression Rating Scale (HDRS) score of 7 points or below. Clinical variables influencing ECT outcome were selected based on prior research.

RESULTS: Data included 1892 MDD patients (N = 1210 women), with a mean age of 59.5 years. Remission rate did not differ among sexes (χ2(1) = 2.0, p = 0.17). We observed significant sex-related interaction effects for duration of index episode (χ2(1) = 4.36, p = 0.04) and for failed psychotherapy in the current episode (χ2(1) = 4.56, p = 0.03). Women's remission rates remained stable regardless of episode duration, while men's remission likelihood decreased with longer episodes. Women treated with prior evidence-based psychotherapy showed lower remission rates than men.

CONCLUSION: This study highlights that ECT is equally effective for both men and women. The tentative sex-related interaction effects are of clinical interest though modest in size. Clinicians must understand sex differences in ECT outcomes and the potential for sex-specific side-effects to make a fully informed decision.

Original language	English
Article number	122117
Journal	Journal of Affective Disorders
Volume	413
Early online date	24 Jun 2026
DOIs	https://doi.org/10.1016/j.jad.2026.122117
Publication status	E-pub ahead of print - 24 Jun 2026

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Blanken, M. A. J. T., Oudega, M. L., Loef, D., Tuijp, P. F. A., Exel, E. V., Somers, M., van Dellen, E., Mocking, R. J. T., Karaszewska, D., de Wit, A. E., Hegeman, J. M., van den Berg, K., Rhebergen, D., Rutten, B. P. F., Broekman, B. F. P., Vergouwen, A. C. M., Zoon, T. J. C., Kok, R. M., Somers, K., ... Dols, A. (2026). Impact of sex differences on the association between clinical predictors and electroconvulsive therapy outcomes: results from the Dutch ECT Consortium (DEC). Journal of Affective Disorders, 413, Article 122117. Advance online publication. https://doi.org/10.1016/j.jad.2026.122117

@article{3f6f0cd6d80c433aa391d88b83060803,

title = "Impact of sex differences on the association between clinical predictors and electroconvulsive therapy outcomes: results from the Dutch ECT Consortium (DEC)",

abstract = "OBJECTIVE: Medical research historically underrepresented women, often generalizing findings from men to women. Sex-specific analyses could enhance guideline accuracy and support personalized care. Electroconvulsive therapy (ECT) is highly effective in major depressive disorder (MDD), however research regarding the impact of sex on ECT efficacy is scarce. This study aimed to explore sex differences in ECT outcome and clinical variables associated with ECT outcome to replicate and extend previous research.METHODS: Clinical data from sites participating in the Dutch ECT Consortium. Remission was defined as a post-ECT Hamilton Depression Rating Scale (HDRS) score of 7 points or below. Clinical variables influencing ECT outcome were selected based on prior research.RESULTS: Data included 1892 MDD patients (N = 1210 women), with a mean age of 59.5 years. Remission rate did not differ among sexes (χ2(1) = 2.0, p = 0.17). We observed significant sex-related interaction effects for duration of index episode (χ2(1) = 4.36, p = 0.04) and for failed psychotherapy in the current episode (χ2(1) = 4.56, p = 0.03). Women's remission rates remained stable regardless of episode duration, while men's remission likelihood decreased with longer episodes. Women treated with prior evidence-based psychotherapy showed lower remission rates than men.CONCLUSION: This study highlights that ECT is equally effective for both men and women. The tentative sex-related interaction effects are of clinical interest though modest in size. Clinicians must understand sex differences in ECT outcomes and the potential for sex-specific side-effects to make a fully informed decision.",

author = "Blanken, \{Machteld A J T\} and Oudega, \{Mardien L\} and Dore Loef and Tuijp, \{Patrick F A\} and Exel, \{E van\} and Metten Somers and \{van Dellen\}, Edwin and Mocking, \{Roel J T\} and Dominika Karaszewska and \{de Wit\}, \{Anouk E\} and Hegeman, \{Johanna M\} and \{van den Berg\}, Karen and Didi Rhebergen and Rutten, \{Bart P F\} and Broekman, \{Birit F P\} and Vergouwen, \{Anton C M\} and Zoon, \{Thomas J C\} and Kok, \{Rob M\} and Karina Somers and Esm{\'e}e Verwijk and Rovers, \{Jordy J E\} and Gijsbert Schuur and \{van Waarde\}, \{Jeroen A\} and Verdijk, \{Joey P A J\} and Dieneke Bloemkolk and Gerritse, \{Frank L\} and \{van Welie\}, Hanneke and Haarman, \{Bartholomeus C M\} and \{van Belkum\}, \{Sjoerd M\} and Maurice Vischjager and Birkenhager, \{Tom K\} and Willemijn Heijnen and Indira Tendolar and \{van Eijndhoven\}, \{Philip F P\} and Annemiek Dols",

note = "Publisher Copyright: {\textcopyright} 2026 The Authors.",

year = "2026",

month = jun,

day = "24",

doi = "10.1016/j.jad.2026.122117",

language = "English",

volume = "413",

journal = "Journal of Affective Disorders",

issn = "0165-0327",

publisher = "Elsevier",

}

Blanken, MAJT, Oudega, ML, Loef, D, Tuijp, PFA, Exel, EV, Somers, M, van Dellen, E, Mocking, RJT, Karaszewska, D, de Wit, AE, Hegeman, JM, van den Berg, K, Rhebergen, D, Rutten, BPF, Broekman, BFP, Vergouwen, ACM, Zoon, TJC, Kok, RM, Somers, K, Verwijk, E, Rovers, JJE, Schuur, G, van Waarde, JA, Verdijk, JPAJ, Bloemkolk, D, Gerritse, FL, van Welie, H, Haarman, BCM, van Belkum, SM, Vischjager, M, Birkenhager, TK, Heijnen, W, Tendolar, I, van Eijndhoven, PFP & Dols, A 2026, 'Impact of sex differences on the association between clinical predictors and electroconvulsive therapy outcomes: results from the Dutch ECT Consortium (DEC)', Journal of Affective Disorders, vol. 413, 122117. https://doi.org/10.1016/j.jad.2026.122117

TY - JOUR

T1 - Impact of sex differences on the association between clinical predictors and electroconvulsive therapy outcomes

T2 - results from the Dutch ECT Consortium (DEC)

AU - Blanken, Machteld A J T

AU - Oudega, Mardien L

AU - Loef, Dore

AU - Tuijp, Patrick F A

AU - Exel, E van

AU - Somers, Metten

AU - van Dellen, Edwin

AU - Mocking, Roel J T

AU - Karaszewska, Dominika

AU - de Wit, Anouk E

AU - Hegeman, Johanna M

AU - van den Berg, Karen

AU - Rhebergen, Didi

AU - Rutten, Bart P F

AU - Broekman, Birit F P

AU - Vergouwen, Anton C M

AU - Zoon, Thomas J C

AU - Kok, Rob M

AU - Somers, Karina

AU - Verwijk, Esmée

AU - Rovers, Jordy J E

AU - Schuur, Gijsbert

AU - van Waarde, Jeroen A

AU - Verdijk, Joey P A J

AU - Bloemkolk, Dieneke

AU - Gerritse, Frank L

AU - van Welie, Hanneke

AU - Haarman, Bartholomeus C M

AU - van Belkum, Sjoerd M

AU - Vischjager, Maurice

AU - Birkenhager, Tom K

AU - Heijnen, Willemijn

AU - Tendolar, Indira

AU - van Eijndhoven, Philip F P

AU - Dols, Annemiek

PY - 2026/6/24

Y1 - 2026/6/24

N2 - OBJECTIVE: Medical research historically underrepresented women, often generalizing findings from men to women. Sex-specific analyses could enhance guideline accuracy and support personalized care. Electroconvulsive therapy (ECT) is highly effective in major depressive disorder (MDD), however research regarding the impact of sex on ECT efficacy is scarce. This study aimed to explore sex differences in ECT outcome and clinical variables associated with ECT outcome to replicate and extend previous research.METHODS: Clinical data from sites participating in the Dutch ECT Consortium. Remission was defined as a post-ECT Hamilton Depression Rating Scale (HDRS) score of 7 points or below. Clinical variables influencing ECT outcome were selected based on prior research.RESULTS: Data included 1892 MDD patients (N = 1210 women), with a mean age of 59.5 years. Remission rate did not differ among sexes (χ2(1) = 2.0, p = 0.17). We observed significant sex-related interaction effects for duration of index episode (χ2(1) = 4.36, p = 0.04) and for failed psychotherapy in the current episode (χ2(1) = 4.56, p = 0.03). Women's remission rates remained stable regardless of episode duration, while men's remission likelihood decreased with longer episodes. Women treated with prior evidence-based psychotherapy showed lower remission rates than men.CONCLUSION: This study highlights that ECT is equally effective for both men and women. The tentative sex-related interaction effects are of clinical interest though modest in size. Clinicians must understand sex differences in ECT outcomes and the potential for sex-specific side-effects to make a fully informed decision.

AB - OBJECTIVE: Medical research historically underrepresented women, often generalizing findings from men to women. Sex-specific analyses could enhance guideline accuracy and support personalized care. Electroconvulsive therapy (ECT) is highly effective in major depressive disorder (MDD), however research regarding the impact of sex on ECT efficacy is scarce. This study aimed to explore sex differences in ECT outcome and clinical variables associated with ECT outcome to replicate and extend previous research.METHODS: Clinical data from sites participating in the Dutch ECT Consortium. Remission was defined as a post-ECT Hamilton Depression Rating Scale (HDRS) score of 7 points or below. Clinical variables influencing ECT outcome were selected based on prior research.RESULTS: Data included 1892 MDD patients (N = 1210 women), with a mean age of 59.5 years. Remission rate did not differ among sexes (χ2(1) = 2.0, p = 0.17). We observed significant sex-related interaction effects for duration of index episode (χ2(1) = 4.36, p = 0.04) and for failed psychotherapy in the current episode (χ2(1) = 4.56, p = 0.03). Women's remission rates remained stable regardless of episode duration, while men's remission likelihood decreased with longer episodes. Women treated with prior evidence-based psychotherapy showed lower remission rates than men.CONCLUSION: This study highlights that ECT is equally effective for both men and women. The tentative sex-related interaction effects are of clinical interest though modest in size. Clinicians must understand sex differences in ECT outcomes and the potential for sex-specific side-effects to make a fully informed decision.

U2 - 10.1016/j.jad.2026.122117

DO - 10.1016/j.jad.2026.122117

M3 - Article

C2 - 42341945

SN - 0165-0327

VL - 413

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

M1 - 122117

ER -

Impact of sex differences on the association between clinical predictors and electroconvulsive therapy outcomes: results from the Dutch ECT Consortium (DEC)

Abstract

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