CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.

CME Objective

After studying this article, you should be able to:

• Identify clinical features of LGBTQ people who have a severe or treatment-resistant mood disorder, including risk factors, treatment needs, and predictors of treatment response to make appropriate treatment decisions for these patients.

Statement of Need and Purpose

Among individuals who identify as lesbian, gay, or bisexual people, suicide attempt has been reported to be twice as common and depression, anxiety, and substance abuse at least 1.5 times more common, and transgender people have been shown to have higher risk of suicidality, interpersonal trauma, and substance use disorders. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Major Depressive Disorder (MDD) states that electroconvulsive therapy (ECT) should be considered as a treatment option for all patients with MDD who have high symptom severity or an urgent need for response, such as patients who are suicidal. However, borderline personality disorder and posttraumatic stress disorder are thought to predict less favorable ECT outcomes and are more prevalent in LGBTQ people. LGBTQ patients are known to experience greater barriers to health care access in general, and little is known about the clinical features of LGBTQ people who have severe or treatment-resistant mood disorders. Clinicians need education on the features associated with treatment-resistant depression in LGBTQ patients and to be able to identify any risk factors and treatment needs that may be specific to this population including predictors of treatment response to assist them in making the most effective and appropriate treatment decisions for these patients.

Release, Expiration, and Review Dates

This educational activity was published in July 2022 and is eligible for AMA PRA Category 1 Credit™ through August 31, 2023. The latest review of this material was July 2022.

Disclosure of Off-Label Usage

Dr Mickey has determined that, to the best of his knowledge, electroconvulsive therapy is not approved by the US Food and Drug Administration for the treatment of schizoaffective disorder, schizophrenia, manic episodes, or mixed episodes.

Funding/Support

No direct funding was received for this research.

Previous presentation

Some of this work was previously reported as a poster at the 2021 Virtual Meeting of the Society of Biological Psychiatry, April 29–May 1, 2021; the 30th annual Virtual Meeting of the International Society of ECT and Neurostimulation, April 24–25, 2021; and the 117th Annual Meeting of the Japanese Society of Psychiatry and Neurology, September 19–21, 2021, Kyoto, Japan.