Document Detail


Pharmacological strategies in the prevention of relapse after electroconvulsive therapy.
MedLine Citation:
PMID:  23303417     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether starting antidepressant medication at the start of electroconvulsive therapy (ECT) reduces post-ECT relapse and to determine whether continuation pharmacotherapy with nortriptyline (NT) and lithium (Li) differs in efficacy or adverse effects from continuation pharmacotherapy with venlafaxine (VEN) and Li.
METHODS: During an acute ECT phase, 319 patients were randomized to treatment with moderate dosage bilateral ECT or high-dosage right unilateral ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN. Of 181 patients to meet post-ECT remission criteria, 122 (67.4%) participated in a second continuation pharmacotherapy phase. Patients earlier randomized to NT or VEN continued on the antidepressant, whereas patients earlier randomized to placebo were now randomized to NT or VEN. Lithium was added for all patients who were followed until relapse or 6 months.
RESULTS: Starting an antidepressant medication at the beginning of the ECT course did not affect the rate or timing of relapse relative to starting pharmacotherapy after ECT completion. The combination of NT and Li did not differ from VEN and Li in any relapse or adverse effect measure. Older age was strongly associated with lower relapse risk, whereas the type of ECT administered in the acute phase and medication resistance were not predictive. Across sites, 50% of the patients relapsed, 33.6% continued in remission 6 months after ECT, and 16.4% dropped out.
CONCLUSIONS: Starting an antidepressant medication during ECT does not affect relapse, and there are concerns about administering Li during an acute ECT course. Nortriptyline and VEN were equally effective in prolonging remission, although relapse rates after ECT are substantial despite intensive pharmacology. As opposed to the usual abrupt cessation of ECT, the impact of an ECT taper should be evaluated.
Authors:
Joan Prudic; Roger F Haskett; W Vaughn McCall; Keith Isenberg; Thomas Cooper; Peter B Rosenquist; Benoit H Mulsant; Harold A Sackeim
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The journal of ECT     Volume:  29     ISSN:  1533-4112     ISO Abbreviation:  J ECT     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-20     Completed Date:  2013-08-06     Revised Date:  2014-04-17    
Medline Journal Info:
Nlm Unique ID:  9808943     Medline TA:  J ECT     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3-12     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Antidepressive Agents / therapeutic use*
Antidepressive Agents, Tricyclic / therapeutic use
Cyclohexanols / therapeutic use
Diagnostic and Statistical Manual of Mental Disorders
Drug Resistance
Educational Status
Electroconvulsive Therapy / adverse effects,  methods*
Female
Humans
Kaplan-Meier Estimate
Lithium Carbonate / therapeutic use
Male
Middle Aged
Nortriptyline / therapeutic use
Psychiatric Status Rating Scales
Recurrence
Survival Analysis
Grant Support
ID/Acronym/Agency:
R01 MH061609/MH/NIMH NIH HHS; R01 MH35636/MH/NIMH NIH HHS; R01 MH61591/MH/NIMH NIH HHS; R01 MH61594/MH/NIMH NIH HHS; R01 MH61609/MH/NIMH NIH HHS; R01 MH61621/MH/NIMH NIH HHS; UL1 TR000005/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Antidepressive Agents; 0/Antidepressive Agents, Tricyclic; 0/Cyclohexanols; 2BMD2GNA4V/Lithium Carbonate; BL03SY4LXB/Nortriptyline; GRZ5RCB1QG/venlafaxine
Comments/Corrections
Comment In:
J ECT. 2013 Mar;29(1):1-2   [PMID:  23422517 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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