The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report.
ABSTRACT As part of a C.O.R.E., multi-site longitudinal study comparing continuation electroconvulsive therapy (ECT) vs. continuation pharmacotherapy, the authors determined the response of 253 patients with major depression to acute-phase, bilateral ECT by use of the 24-item Hamilton Rating Scale for Depression. Remission rates for three age-groups, > or =65 years; 46-64 years; and < or =45 years, were 90 percent, 89.8 percent, and 70 percent, respectively. Age, as a continuous variable, positively influenced response to treatment. Bilateral, dose-titrated ECT is a highly effective acute treatment for major depression, and older age confers a greater likelihood of achieving remission.
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ABSTRACT: Electroconvulsive therapy (ECT) is utilized worldwide for various severe and treatment-resistant psychiatric disorders. Research studies have shown that ECT is the most effective and rapid treatment available for elderly patients with depression, bipolar disorder and psychosis. For patients who suffer from intractable catatonia and neuroleptic malignant syndrome, ECT can be life saving. For elderly patients who cannot tolerate or respond poorly to medications and who are at a high risk for drug-induced toxicity or toxic drug interactions, ECT is the safest treatment option. Organic causes are frequently associated with late-life onset of neuropsychiatric conditions, such as parkinsonism, dementia and stroke. ECT has proven to be efficacious even when these conditions are present. During the next decade, research studies should focus on the use of ECT as a synergistic therapy, to enhance other biological and psychological treatments, and prevent symptom relapse and recurrence.Neuropsychiatry. 02/2014; 4(1):33-54.
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ABSTRACT: Electroconvulsive therapy (ECT) is an effective treatment for patients with severe depression. Knowledge on factors predicting therapeutic response may help to identify patients who will benefit most from the intervention. Based on the neuroplasticity hypothesis, volumes of the amygdala and hippocampus are possible candidates for predicting treatment outcome. Therefore, this prospective cohort study examines the predictive value of amygdala and hippocampal volumes for the effectiveness of ECT. Prior to ECT, 53 severely unipolar depressed patients [mean age 57 ± 14 years; 40% (n = 21) male] received structural magnetic resonance imaging (MRI) at 1.5 T. Normalized amygdala and hippocampal volumes were calculated based on automatic segmentation by FreeSurfer (FS). Regression analyses were used to test if the normalized volumes could predict the response to a course of ECT based on the Montgomery-Åsberg Depression Rating Scale (MADRS) scores. A larger amygdala volume independently and significantly predicted a lower post-ECT MADRS score (β = -0.347, P = 0.013). The left amygdala volume had greater predictive value for treatment outcome relative to the right amygdala volume. Hippocampal volume had no independent predictive value. A larger pre-treatment amygdala volume predicted more effective ECT, independent of other known predictors. Almost all patients continued their medication during the study, which might have influenced the course of treatment in ways that were not taken into account.Frontiers in Psychiatry 11/2014; 5:169.
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ABSTRACT: Background Depression is the leading cause of disability worldwide and electroconvulsive therapy (ECT) is the most potent therapy. We investigated the clinical response and regional cerebral blood flow changes in depressed inpatients treated with (ECT) in a repeated longitudinal study. Method: Forty-nine patients (21 men and 28 women) with a mean age 61 years underwent ECT. Forty-one patients grading improvement after the initial ECT-series (responder group), was compared with eight, grading no improvement (non-responder group). The patients underwent neuropsychiatric ratings, measure of clinical response (defined as≥50% reduction of pre-treatment depression score) and measure of regional cerebral blood flow (rCBF). Results The responder group had an initial 60% to 82%, and the non-responder group a 30% to 64% clinical response throughout the follow-up. The non-responder group showed more reported depression (p=.003), and vegetative anxiety (p=.024), with a generally higher left temporal rCBF (p=.045). Limitations The retrospective approach and the small sample-size. Conclusion Patients with no subjective improvement after ECT had lesser objective clinical response, more sustained reported depression with anxiety features, and higher left temporal rCBF.Journal of Affective Disorders 10/2014; · 3.71 Impact Factor