Combination of Pharmacotherapy With Electroconvulsive Therapy in Prevention of Depressive Relapse A Pilot Controlled Trial
ABSTRACT 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.
Full-textDOI: · Available from: Ayşegül Yildiz, Jul 24, 2014
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ABSTRACT: High rates of early relapse following electroconvulsive therapy (ECT) are typically reported in the literature. Current treatment guidelines offer little information to clinicians on the optimal nature of maintenance therapy following ECT. The aim of this study was to provide a systematic overview of the existing evidence regarding post ECT relapse. A keyword search of electronic databases was performed for studies appearing in the peer-reviewed literature before January 2013 reporting on relapse rates in responders to an acute course of ECT administered for a major depressive episode. Meta-analyses were performed where appropriate. Thirty-two studies with up to two years' duration of follow-up were included. In modern-era studies of continuation pharmacotherapy, 51.1% (95% CI=44.7-57.4%) of patients relapsed by 12 months following successful initial treatment with ECT, with the majority (37.7%, 95% CI=30.7-45.2%) relapsing within the first six months. The six-month relapse rate was similar in patients treated with continuation ECT (37.2%, 95% CI=23.4-53.5%). In randomised controlled trials, antidepressant medication halved the risk of relapse compared to placebo in the first six months (risk ratio=0.49, 95% CI=0.39-0.62, p<0.0001, number needed to treat=3.3). Despite continuation therapy, the risk of relapse within the first year following ECT is substantial, with the period of greatest risk being the first six months. The largest evidence base for efficacy in post ECT relapse prevention exists for tricyclic antidepressants. Published evidence is limited or non-existent for commonly used newer antidepressants or popular augmentation strategies. Maintenance of well-being following successful ECT needs to be improved.Neuropsychopharmacology accepted article preview online, 18 June 2013; doi:10.1038/npp.2013.149.Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 06/2013; DOI:10.1038/npp.2013.149 · 7.83 Impact Factor
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ABSTRACT: Objective: Divergent opinion surrounds the use of continuation/maintenance electroconvulsive therapy (c/mECT) as a recurrence prevention strategy in depression because of limited data on efficacy and adverse effects. In an effort to synthesize what is known about its efficacy, a systematic review of controlled studies reporting efficacy of c/mECT for the prevention of relapse or recurrence of a depressive episode in adults with unipolar major depression was conducted. Methods: Eleven electronic databases were searched with a 3-stage screening process conducted by the author with an independent review. Quality assessments and data extractions were performed on selected studies using preselected tools. Results: Six studies met the inclusion criteria; these are as follows: 3 randomized controlled trials, 1 small nonrandomized controlled trial, and 2 retrospective chart reviews. All participants had undergone an index course of electroconvulsive therapy with positive effects before receiving c/mECT or control/comparison interventions. One randomized controlled trial and retrospective chart review showed no significant difference between c/mECT and control/comparison interventions; the remaining 4 studies showed a significantly superior effect of c/mECT for the prevention of recurrence of depression. Monotherapy of c/mECT was less efficacious than c/mECT in combination with antidepressant medication, as was c/mECT delivered on a schedule, which was unresponsive to early signs of recurrence. Conclusions: This review suggests that c/mECT is efficacious for the prevention of relapse/recurrence of major depression and that efficacy is increased when c/mECT is provided in combination with antidepressant medication and at flexible treatment intervals, responsive to early signs of recurrence.Journal of Ect 06/2014; 30(3). DOI:10.1097/YCT.0000000000000085 · 1.39 Impact Factor
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ABSTRACT: A medida que aumente la edad de la población, las cohortes sucesivas de adultos de edad avanzada sufrirán trastornos depresivos. La depresión a una edad avanzada comporta un riesgo adicional de suicidio, comorbilidad médica, discapacidad y carga de los familiares cuidadores. Aunque las tasas de respuesta y de remisión con la farmacoterapia y la terapia electroconvulsiva son comparables en los pacientes con depresión a una edad media de la vida, las tasas de recaída son más altas, lo cual subraya la dificultad que comporta alcanzar y mantener un estado de bienestar. En este artículo se revisa la base de evidencia existente respecto a las opciones de tratamiento de la depresión en el anciano y se presenta un análisis de las opciones terapéuticas disponibles para las variantes difíciles de tratar (p. ej., depresión psicótica, depresión vascular). Se revisan también los algoritmos de tratamiento basados en los factores predictivos de la respuesta, así como las nuevas opciones terapéuticas prometedoras.10/2012; 19(4):116-126. DOI:10.1016/j.psiq.2012.07.005