Continuation ECT as Good, or Poor, as Drug Therapy for Preventing Depression Relapse

Dec 6 2006
Reuters Health Information
NEW YORK (Reuters Health) Dec 06 – Electroconvulsive therapy (ECT) is comparable to pharmacologic treatment in preventing relapse of depression, but both approaches have limited efficacy, investigators report in the December Archives of General Psychiatry.
While electroconvulsive therapy is extremely effective for acute treatment of major depression, ECT is also being used as continuation or maintenance treatment (C-ECT) to prevent relapse. However, there are few data to support such use, note Dr. Charles H. Kellner and colleagues at five different academic clinical centers.
Dr. Kellner, from the UMDNJ New Jersey Medical School in Newark, and members of the CORE group (Consortium for Research in ECT) conducted a two-phase trial with 531 patients with primary major depressive disorder.
The first phase involved a course of bilateral ECT delivered three times per week for all the subjects until their illness went into remission. Participants who maintained remission at 1 week were then randomly assigned in the second phase to continuation ECT or a combination of nortriptyline and lithium.
ECT was administered weekly for 4 weeks, every other week for 8 weeks, and monthly for 2 months.
Relapse rates were 37.1% for C-ECT and 31.6% for medication treatment. In the two arms, 46.1% and 46.3% remained in remission, respectively, while 16.8% and 22.1% dropped out.
Subjects in both groups who remained in remission showed similarly improved cognitive abilities during the course of the trial, as assessed by the modified MMSE.
“An important interpretation of these data is that relapse or treatment discontinuation rates after successful ECT remain unacceptably high with standard treatment regimens,” Dr. Kellner and his team write, although they acknowledge that both types of treatment were “modestly effective in preventing depressive relapse.”
However, they caution that failure to detect significant differences between groups “cannot be taken to mean that the outcomes in the two groups are equal.” Instead, their advice is to decide treatment options “based on judgments about tolerability for the individual patient and patient preference.”
They hope that further research will turn up biomarkers to predict which patients will respond better to one or the other treatment. They also suggest that better remission rates might be achieved by combining C-ECT and medication therapy.
Arch Gen Psychiatry 2006;63:1337-1344.

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