Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression

• DOI: 10.1001/archpsyc.63.12.1337
• Publication Date: 2006-12-04T21:07:51Z
• Authors: Charles H. Kellner; Rebecca G. Knapp; Georgios Petrides; Teresa A. Rummans; Mustafa M. Husain; Keith Rasmussen; Martina Mueller; Hilary J. Bernstein; Kevin O’Connor; Glenn Smith; Melanie Biggs; Samuel H. Bailine; Chitra Malur; Eunsil Yim; Shawn McClintock; Shirlene Sampson; Max Fink
• Keywords: Depression; Pharmacotherapy

<h3>Background</h3> Although electroconvulsive therapy (ECT) has been shown to be extremely effective for the acute treatment of major depression, it never systematically assessed as a strategy relapse prevention. <h3>Objective</h3> To evaluate comparative efficacy continuation ECT (C-ECT) and combination lithium carbonate plus nortriptyline hydrochloride (C-Pharm) in prevention depressive relapse. <h3>Design</h3> Multisite, randomized, parallel design, 6-month trial performed from 1997 2004. <h3>Setting</h3> Five academic medical centers their outpatient psychiatry clinics. <h3>Patients</h3> Two hundred one patients with Structured Clinical Interview for<i>DSM-IV–</i>diagnosed unipolar depression who had remitted course bilateral ECT. <h3>Interventions</h3> Random assignment 2 groups receiving either C-ECT (10 treatments) or C-Pharm 6 months. <h3>Main Outcome Measure</h3> Relapse compared between groups. <h3>Results</h3> In group, 37.1% experienced disease relapse, 46.1% continued have remission at study end, 16.8% dropped out study. 31.6% 46.3% remission, 22.1% Both Kaplan-Meier Cox proportional hazards regression analyses indicated no statistically significant differences overall survival curves time Mean ± SD group was 9.1 7.0 weeks 6.7 4.6 (<i>P</i> = .13). proportions significantly lower than historical placebo control similarly designed <h3>Conclusions</h3> were superior control, but both limited efficacy, more half experiencing dropping Even strategies mood disorders are urgently needed.