Combination of Pharmacotherapy With Electroconvulsive Therapy in Prevention of Depressive Relapse A Pilot Controlled Trial

Department of Psychiatry, Dokuz Eylül University, Izmir, Turkey.
The journal of ECT (Impact Factor: 1.39). 11/2009; 26(2):104-10. DOI: 10.1097/YCT.0b013e3181c189f7
Source: PubMed


Relapse rates after electroconvulsive therapy (ECT) remain high with standard treatments. We aimed to test the efficacy of an early administered continuation pharmacotherapy (c-pharm early) strategy in prevention of post-ECT relapse.
A 20-week, randomized, double-blind, placebo-controlled trial. Patients aged 18 to 65 years diagnosed with Diagnostic and Statistical Manual of Mental Disorders major depressive disorder, with or without psychotic features, with initial Montgomery-Asberg Depression Rating Scale scores higher than 22, underwent 8 bilateral ECT sessions (2 per week). Randomization to c-pharm early, c-pharm late, and placebo groups in 2:2:1, respectively, was performed at the completion of the fourth ECT session. After randomization, subjects in the c-pharm early group were given sertraline at 150 mg/d. Subjects in the c-pharm late group were first given placebo, which was substituted with sertraline at 150 mg/d at the completion of the eight ECT. Relapse was defined as a Montgomery-Asberg Depression Rating Scale score of 16 or higher.
Seventy-three percent of the patients responded to the given treatment. The relapse rates were 12.5% in the c-pharm early group, 28% in the c-pharm late group, and 67% in the placebo group (P = 0.09). The c-pharm early strategy resulted in significantly lower relapse rates and longer well time compared with the placebo (P = 0.04). When the trend with the initiation of the c-pharm intervention was investigated in the 3 groups with equally spaced trend weights, the time of initiation was found to have a significant effect on the probability of the remaining well (P = 0.03).
Comparative efficacy of c-pharm early and late strategies in providing improved protection against post-ECT relapse of major depressive disorder needs to be further explored.

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Available from: Ayşegül Yildiz, Jul 24, 2014
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    • "RRs of relapse in RCTs of active relapse prevention strategies vs placebo were investigated at 3 and 6 months after ECT (Figure 4a and b). For the 3-month follow-up, three placebo-controlled RCTs (N ¼ 128) provided extractable data: two (Lauritzen et al, 1996; Yildiz et al, 2010) evaluating selective serotonin reuptake inhibitor (SSRI) monotherapy vs placebo and the other (Sackeim et al, 2001) comparing TCA monotherapy and TCA–lithium combination to placebo. The first Figure 3 Outcomes at 3, 12, and 24 months following ECT. "
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