Skip to main content Accessibility help
×
Home
Hostname: page-component-5959bf8d4d-89n48 Total loading time: 0.423 Render date: 2022-12-09T15:14:48.631Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

More data on speed of remission with ECT in geriatric depression

Published online by Cambridge University Press:  02 January 2018

Charles H. Kellner
Affiliation:
Department of Psychiatry, Icahn School of Medicine, USA. Email: charles.kellner@mssm.edu.
Emma T. Geduldig
Affiliation:
Department of Psychiatry, Icahn School of Medicine
Rebecca G. Knapp
Affiliation:
Department of Public Health Sciences, Medical University of South Carolina
Robert C. Young
Affiliation:
Department of Psychiatry, Weill Medical College of Cornell University
Richard D. Weiner
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
Robert M. Greenberg
Affiliation:
Geriatric Psychiatry, Lutheran Medical Center
Joan Prudic
Affiliation:
New York State Psychiatric Institute and the College of Physicians and Surgeons of Columbia University
W. Vaughn McCall
Affiliation:
Department of Psychiatry and Health Behavior, Georgia Regents University
Georgios Petrides
Affiliation:
Department of Psychiatry, Hofstra North Shore–LIJ School of Medicine at Hofstra University
Mustafa M. Husain
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
Matthew V. Rudorfer
Affiliation:
Somatic Treatments Program, National Institute of Mental Health
Sarah H. Lisanby
Affiliation:
JP Gibbons Professor and Chair, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
Rights & Permissions[Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2015 

We appreciate the important contribution of Spaans et al Reference Spaans, Sienaert, Bouckaert, van den Berg, Verwijk and Kho1 to the evidence that electroconvulsive therapy (ECT) is a rapidly acting treatment in geriatric depression. Their data are a reminder that, despite the recent excitement about other neuromodulation modalities for the treatment of depression, ECT remains a standard and vital treatment for our most seriously ill patients, particularly those in the geriatric age group. We would like to add data about the speed of ECT remission in geriatric depression from the ongoing National Institute of Mental Health (NIMH)-supported multicentre trial, Prolonging Remission in Depressed Elderly (PRIDE, ClinicalTrials.gov Identifier: NCT01028508).

Our group has just completed enrolment of 237 patients in phase 1 of a trial in which patients with unipolar depression over 60 years of age receive a course of ultra-brief pulse right unilateral ECT augmented with venlafaxine. (Phase 2 of the trial is random allocation to venlafaxine plus lithium or venlafaxine plus lithium plus flexible maintenance ECT. This phase of the trial will be completed in the next 3 months.) The cohort of 133 remitters in phase 1 required a mean of 7.3 (s.d. = 3.1) ECT sessions to reach remission, defined as a Hamilton Rating Scale for Depression (HRSD-24) score of ≤10 on two consecutive occasions (personal communication, R. Knapp). Because ECT was administered three times a week in our study, seven treatments approximate 2.5 weeks until remission, a time comparable to that reported by Spaans et al.

In our previous study, comparing the efficacy of the three standard electrode placements in ECT, Reference Kellner, Knapp, Husain, Rasmussen, Sampson and Cullum2 the mean number of ECT sessions needed to achieve remission in patients over 60 years of age was also consistently low: bi-temporal (5.5, s.d. = 2.2, n = 19), bi-frontal (5.4, s.d. = 2.1, n = 11), right unilateral brief pulse (5.1, s.d. = 2.1, n = 19). Speed of response takes on added importance when patients are urgently ill and present with severe suicidal urges, agitation, psychosis, or malnutrition from profound depression. Because of its unsurpassed efficacy and now better-documented speed of response in geriatric depression, ECT should no longer be relegated to last place in treatment algorithms for severe depression. Reference Eranti and McLoughlin3 Finally, it should be noted that in both Spaans et al and the PRIDE study, newer techniques allow practitioners to prescribe ECT in a form that is more tolerable for patients than in the past. Reference Prudic4

References

1 Spaans, HP, Sienaert, P, Bouckaert, F, van den Berg, JF, Verwijk, E, Kho, KH, et al. Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication. Br J Psychiatry 2015; 206 6771.CrossRefGoogle ScholarPubMed
2 Kellner, CH, Knapp, R, Husain, MM, Rasmussen, K, Sampson, S, Cullum, M, et al. Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. Br J Psychiatry 2010; 196: 226–34.CrossRefGoogle ScholarPubMed
3 Eranti, SV, McLoughlin, DM. Electroconvulsive therapy – state of the art. Br J Psychiatry 2003; 182: 89.CrossRefGoogle ScholarPubMed
4 Prudic, J. Strategies to minimize cognitive side effects with ECT: aspects of ECT technique. J ECT 2008; 24: 4651.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.
You have Access
5
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

More data on speed of remission with ECT in geriatric depression
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

More data on speed of remission with ECT in geriatric depression
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

More data on speed of remission with ECT in geriatric depression
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *