Continuation ECT: relapse prevention in affective disorders.
ABSTRACT Relapse rates after the acute treatment of affective disorders with drugs or electroconvulsive therapy (ECT) are high (often 50-95%), despite preventive pharmacotherapy. In practice, some patients receive continuation and maintenance ECT after successful treatment of the index episode with ECT. We reviewed the charts of patients with affective illnesses who received continuation ECT (C-ECT) in our inpatient service from 1985 to 1991. In 33 courses of C-ECT, mean intertreatment interval was 10.1 days and the average duration of treatment was 10 weeks. One-year follow-up was available for 21 patients. Seven (33%) patients relapsed and needed re-admission within 1 year. The relapse rate for the patients with delusional depression was 42%, lower than the 95% reported for patients with delusional depression maintained on continuation pharmacotherapy before the C-ECT program started in our facility. No single factor examined was a significant predictor of relapse except C-ECT, which exhibited a sustained prophylactic effect for the year after the index episode.
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ABSTRACT: Patients with major depressive disorder (MDD) who require an acute course of electroconvulsive therapy (ECT) have high relapse rates. Therefore, an effective maintenance treatment strategy needs to be established. Continuation and maintenance ECT (C/M-ECT) could be an adequate treatment option, although the lack of controlled studies has led to its usefulness being questioned. This review includes a detailed description of studies on the effectiveness/efficacy of ECT in MDD. Despite their methodological limitations, the results appear to support the idea that C/M-ECT would be a safe and effective alternative, especially in patients with severe and recurrent disease. Nevertheless, more controlled studies are needed to provide new evidence and allow a more accurate assessment of the efficacy, safety and pattern of use of C/M-ECT.Revista de Psiquiatría Biológica y Salud Mental 10/2012; 5(4):241–253. · 0.31 Impact Factor
Article: Psychotic Depression[Show abstract] [Hide abstract]
ABSTRACT: Psychotic depression, although considered in DSM-IV to he a subtype of major depression, has many features of a separate disorder, including its own distinct phenomenology, epidemiology, family history, course of illness, biology and treatment. When evaluating patients with both depressive and psychotic symptoms, it is important to always consider psychotic depression as a possible diagnosis, as well as other diagnoses which may resemble it, such as bipolar disorder, schizoaffective disorder, schizophrenia with superimposed depression, delusional disorder and obsessive-compulsive disorder with poor insight and com-orbid depression. Although patients with psychotic depression and those with depression without psychotic symptoms appear to respond equally well to electroconvulsive therapy (ECT), numerous studies have shown a significant lack of response to tricyclic antidepressants (TCAs) in the former group of patients compared with the latter. However, patients with psychotic depression appear to respond significantly better to combinations of antidepressants and antipsychotics. There is disagreement as to whether ECT is superior to combined TCA-antipsychotic treatment. Most researchers agree, however, that both are effective first-line treatments for psychotic depression. Amoxapine, selective serotonin (5-hydroxytrypt-amine; 5-HT) reuptake inhibitor (SSRI) monotherapy, and combination treatment with an SSRI and an antipsychotic, are promising as possible additional first-line treatments. Atypical antipsychotics and the addition of lithium or other mood stabilisers to an antidepressant-antipsychotic regimen are potential treatments for patients with refractory psychotic depression. Psychotic depression is a recurrent disorder with a high rate of relapse after successful initial treatment with medications or ECT. The rate of relapse appears to be especially high when no maintenance therapy is used or when the antipsychotic drug of an antidepressant-antipsychotic combination is tapered off prematurely. Maintenance ECT is a promising tool for preventing relapse after initial ECT treatment. Additional studies of psychotic depression are needed to better determine the effectiveness of new treatments as well as to help resolve how to most effectively prevent relapse after acute treatment of this disorder.CNS Drugs 12/1997; 8(6). · 4.38 Impact Factor