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ECT sustains mood improvement in remitted geriatric depression

Recent findings showed efficacy of additional electroconvulsive therapy and medication following remission of major depression in older adults.

“Because of its rapid speed of response, [electroconvulsive therapy (ECT)] is the treatment of choice for urgently ill patients, including those with psychosis and strong suicidal ideation from depression. Shortcomings of ECT have included a less-than-optimal tolerability profile, with adverse cognitive effects, as well as high relapse rates in the 6-month period after remission,” Charles H. Kellner, MD, of Icahn School of Medicine at Mount Sinai, Columbia University and New York State Psychiatric Institute, and colleagues wrote.

To address these shortcomings, researchers conducted the Prolonging Remission in Depressed Elderly (PRIDE) study, a two-phase multisite study among adults aged 60 years or older with unipolar major depressive disorder. In phase 1, study participants (n = 1,240) received acute ECT three times per week in combination with open-label venlafaxine. In phase 2, the intent-to-treat sample of 120 participants who remitted in phase 1 were randomly assigned to receive only venlafaxine plus lithium for 24 weeks or ECT plus venlafaxine plus lithium.

At 24 weeks, 24-item Hamilton Depression Rating Scale scores were significantly lower among individuals who received ECT plus medication, with a difference in adjusted mean scores of 4.2 (95% CI, 1.6-6.9) at study end.

Significantly more participants who received ECT plus medication were rated “not ill at all” on the Clinical Global Impressions severity scale, compared with those who received only medication.

Sarah H. Lisanby

Mini-Mental State Examination scores were not statistically significantly different between treatment groups.

“The PRIDE study demonstrates that continuing ECT treatment following remission in a manner that is responsive to the needs of individual patients can maintain relief from depression and at the same time, avoid overtreatment,” study researcher Sarah H. Lisanby, MD, of Duke University School of Medicine and director of NIMH’s Division of Translational Research, said in a press release. “For older persons with depression, many of whom do not respond to other treatments, PRIDE offers information in support of ECT as an effective and safe option for both initial and maintenance treatment.” – by Amanda Oldt

Disclosure: Kellner receives honoraria from UpToDate, Psychiatric Times, and Northwell Health and royalties from Cambridge University Press. Please see the full study for a list of all authors’ relevant financial disclosures.