Project: Research project

Project Details


This is a revision of a Geriatric Mental Health Academic Award. This
Academic Investigator Award will provide the educational experience and
mentorship necessary for the principal investigator to develop as a
contributing clinical scientist in the areas of electroconvulsive therapy
(ECT) and depression in the elderly. Clinical depression occurs commonly
in the elderly. ECT is the treatment of choice when the elderly cannot
tolerate or do not respond to antidepressant medication. The primary side
effect of ECT in the elderly is reversible cognitive impairment. The
cognitive side effects can be reduced by using brief pulse, right
unilateral ECT. More recent efforts to further improve the efficacy of
ECT while reducing the cognitive side effects have focused on strategies
to dose the intensity of the electrical stimulus to correspond to the
patient's requirement for an electrically induced seizure (seizure
threshold). The seizure threshold varies widely between subjects; a
stimulus dose far in excess of threshold contributes to side effects while
too low a dose will not have antidepressant activity. This project will
randomize elderly depressed patients to receive either a fixed, high dose
stimulus (which is the standard in the U.S.) or a stimulus dose titrated
only moderately in excess of the individual's seizure threshold. The
difference between these two groups in the rate of antidepressant response
and the severity of cognitive side effects will be measured. I predict
that titrated ECT will result in less cognitive side effects in the
elderly than fixed dose ECT.

The academic portion of this proposal will provide for class work in
statistics and epidemiology. Further, this proposal will allow active
study and dialogue with Drs. Burton Reifler, Harold Sackeim, Richard
Weiner, David Reboussin, and Frank Wood who are experts in the areas of
dementia, depression, ECT, and biostatistics cognitive testing.
Completion of the academic portion of this proposal will provide the tools
necessary to complete the scientific project and develop as an
investigator in geriatric depression and treatment.
StatusNot started