A novel strategy for continuation ECT in geriatric depression

Phase 2 of the PRIDE study

CORE/PRIDE Work Group

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Objective:Therandomized phase (phase 2) of the Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy and tolerability of continuation ECT plus medication compared with medication alone in depressed geriatric patients after a successful course of ECT (phase 1). Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, augmented with venlafaxine. Phase 2 compared two randomized treatment arms: A medication only arm (venlafaxine plus lithium, over 24 weeks) and an ECT plus medication arm(four continuationECTtreatmentsover1month, plusadditionalECT as needed, using the Symptom-Titrated, Algorithm-Based Longitudinal ECT [STABLE] algorithm, while continuing venlafaxine plus lithium). The intent-To-Treat sample comprised 120 remitters from phase 1. The primary efficacy outcome measure was score on the 24-item Hamilton Depression Rating Scale (HAM-D), and the secondary efficacy outcome was score on the Clinical Global Impressions severity scale (CGI-S). Tolerability as measured by neurocognitive performance (reported elsewhere) was assessed using an extensive test battery; global cognitive functioning as assessed by the Mini-Mental State Examination (MMSE) is reported here. Longitudinal mixed-effects repeated-measures modeling was used to compare ECT plus medication and medication alone for efficacy and global cognitive function outcomes. Results: At 24 weeks, the ECT plus medication group had statistically significantly lower HAM-D scores than the medication only group. The difference in adjustedmean HAM-D scores at study end was 4.2 (95% CI=1.6, 6.9). Significantly more patients in the ECT plus medication group were rated "not ill at all" on the CGI-S compared with the medication only group. There was no statistically significant difference between groups in MMSE score. Conclusions: Additional ECT after remission (here operationalized as four continuation ECT treatments followed by furtherECTonly as needed)wasbeneficial in sustainingmood improvement for most patients.

Original languageEnglish (US)
Pages (from-to)1110-1118
Number of pages9
JournalAmerican Journal of Psychiatry
Volume173
Issue number11
DOIs
StatePublished - Nov 1 2016

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Geriatrics
Depression
Lithium
Cognition
Outcome Assessment (Health Care)
Therapeutics
Venlafaxine Hydrochloride

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

A novel strategy for continuation ECT in geriatric depression : Phase 2 of the PRIDE study. / CORE/PRIDE Work Group.

In: American Journal of Psychiatry, Vol. 173, No. 11, 01.11.2016, p. 1110-1118.

Research output: Contribution to journalArticle

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title = "A novel strategy for continuation ECT in geriatric depression: Phase 2 of the PRIDE study",
abstract = "Objective:Therandomized phase (phase 2) of the Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy and tolerability of continuation ECT plus medication compared with medication alone in depressed geriatric patients after a successful course of ECT (phase 1). Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, augmented with venlafaxine. Phase 2 compared two randomized treatment arms: A medication only arm (venlafaxine plus lithium, over 24 weeks) and an ECT plus medication arm(four continuationECTtreatmentsover1month, plusadditionalECT as needed, using the Symptom-Titrated, Algorithm-Based Longitudinal ECT [STABLE] algorithm, while continuing venlafaxine plus lithium). The intent-To-Treat sample comprised 120 remitters from phase 1. The primary efficacy outcome measure was score on the 24-item Hamilton Depression Rating Scale (HAM-D), and the secondary efficacy outcome was score on the Clinical Global Impressions severity scale (CGI-S). Tolerability as measured by neurocognitive performance (reported elsewhere) was assessed using an extensive test battery; global cognitive functioning as assessed by the Mini-Mental State Examination (MMSE) is reported here. Longitudinal mixed-effects repeated-measures modeling was used to compare ECT plus medication and medication alone for efficacy and global cognitive function outcomes. Results: At 24 weeks, the ECT plus medication group had statistically significantly lower HAM-D scores than the medication only group. The difference in adjustedmean HAM-D scores at study end was 4.2 (95{\%} CI=1.6, 6.9). Significantly more patients in the ECT plus medication group were rated {"}not ill at all{"} on the CGI-S compared with the medication only group. There was no statistically significant difference between groups in MMSE score. Conclusions: Additional ECT after remission (here operationalized as four continuation ECT treatments followed by furtherECTonly as needed)wasbeneficial in sustainingmood improvement for most patients.",
author = "{CORE/PRIDE Work Group} and Kellner, {Charles H.} and Husain, {Mustafa M.} and Knapp, {Rebecca G.} and McCall, {William Vaughn} and Georgios Petrides and Rudorfer, {Matthew V.} and Young, {Robert C.} and Shirlene Sampson and McClintock, {Shawn M.} and Martina Mueller and Joan Prudic and Greenberg, {Robert M.} and Weiner, {Richard D.} and Bailine, {Samuel H.} and Rosenquist, {Peter B.} and Ahmad Raza and Styliani Kaliora and Vassilios Latoussakis and Tobias, {Kristen G.} and Briggs, {Mimi C.} and Liebman, {Lauren S.} and Geduldig, {Emma T.} and Teklehaimanot, {Abeba A.} and Mary Dooley and Lisanby, {Sarah H.} and Gabriella Ahle and Aloysi, {Amy S.} and Ethan Bryson and Kate Farber and Matthew Majeske and Elizabeth Muller and Roya Nazarian and Rosa Pasculli and Ashly Cochran and Evans, {Laura D.} and David Friedman and Nabil Kotbi and Bryony Lucas and Arielle Rogers and Brittany Gubosh and Chelsea Hodges and Laryssa McCloud and Riley, {Mary Anne} and Raphael Braga and Ingrid Fuentes and Ketan Hiranpara and Muhammad Khan and Carmel Powers and Susan Ray and Youssef, {Nagy Adel}",
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T1 - A novel strategy for continuation ECT in geriatric depression

T2 - Phase 2 of the PRIDE study

AU - CORE/PRIDE Work Group

AU - Kellner, Charles H.

AU - Husain, Mustafa M.

AU - Knapp, Rebecca G.

AU - McCall, William Vaughn

AU - Petrides, Georgios

AU - Rudorfer, Matthew V.

AU - Young, Robert C.

AU - Sampson, Shirlene

AU - McClintock, Shawn M.

AU - Mueller, Martina

AU - Prudic, Joan

AU - Greenberg, Robert M.

AU - Weiner, Richard D.

AU - Bailine, Samuel H.

AU - Rosenquist, Peter B.

AU - Raza, Ahmad

AU - Kaliora, Styliani

AU - Latoussakis, Vassilios

AU - Tobias, Kristen G.

AU - Briggs, Mimi C.

AU - Liebman, Lauren S.

AU - Geduldig, Emma T.

AU - Teklehaimanot, Abeba A.

AU - Dooley, Mary

AU - Lisanby, Sarah H.

AU - Ahle, Gabriella

AU - Aloysi, Amy S.

AU - Bryson, Ethan

AU - Farber, Kate

AU - Majeske, Matthew

AU - Muller, Elizabeth

AU - Nazarian, Roya

AU - Pasculli, Rosa

AU - Cochran, Ashly

AU - Evans, Laura D.

AU - Friedman, David

AU - Kotbi, Nabil

AU - Lucas, Bryony

AU - Rogers, Arielle

AU - Gubosh, Brittany

AU - Hodges, Chelsea

AU - McCloud, Laryssa

AU - Riley, Mary Anne

AU - Braga, Raphael

AU - Fuentes, Ingrid

AU - Hiranpara, Ketan

AU - Khan, Muhammad

AU - Powers, Carmel

AU - Ray, Susan

AU - Youssef, Nagy Adel

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Objective:Therandomized phase (phase 2) of the Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy and tolerability of continuation ECT plus medication compared with medication alone in depressed geriatric patients after a successful course of ECT (phase 1). Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, augmented with venlafaxine. Phase 2 compared two randomized treatment arms: A medication only arm (venlafaxine plus lithium, over 24 weeks) and an ECT plus medication arm(four continuationECTtreatmentsover1month, plusadditionalECT as needed, using the Symptom-Titrated, Algorithm-Based Longitudinal ECT [STABLE] algorithm, while continuing venlafaxine plus lithium). The intent-To-Treat sample comprised 120 remitters from phase 1. The primary efficacy outcome measure was score on the 24-item Hamilton Depression Rating Scale (HAM-D), and the secondary efficacy outcome was score on the Clinical Global Impressions severity scale (CGI-S). Tolerability as measured by neurocognitive performance (reported elsewhere) was assessed using an extensive test battery; global cognitive functioning as assessed by the Mini-Mental State Examination (MMSE) is reported here. Longitudinal mixed-effects repeated-measures modeling was used to compare ECT plus medication and medication alone for efficacy and global cognitive function outcomes. Results: At 24 weeks, the ECT plus medication group had statistically significantly lower HAM-D scores than the medication only group. The difference in adjustedmean HAM-D scores at study end was 4.2 (95% CI=1.6, 6.9). Significantly more patients in the ECT plus medication group were rated "not ill at all" on the CGI-S compared with the medication only group. There was no statistically significant difference between groups in MMSE score. Conclusions: Additional ECT after remission (here operationalized as four continuation ECT treatments followed by furtherECTonly as needed)wasbeneficial in sustainingmood improvement for most patients.

AB - Objective:Therandomized phase (phase 2) of the Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy and tolerability of continuation ECT plus medication compared with medication alone in depressed geriatric patients after a successful course of ECT (phase 1). Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, augmented with venlafaxine. Phase 2 compared two randomized treatment arms: A medication only arm (venlafaxine plus lithium, over 24 weeks) and an ECT plus medication arm(four continuationECTtreatmentsover1month, plusadditionalECT as needed, using the Symptom-Titrated, Algorithm-Based Longitudinal ECT [STABLE] algorithm, while continuing venlafaxine plus lithium). The intent-To-Treat sample comprised 120 remitters from phase 1. The primary efficacy outcome measure was score on the 24-item Hamilton Depression Rating Scale (HAM-D), and the secondary efficacy outcome was score on the Clinical Global Impressions severity scale (CGI-S). Tolerability as measured by neurocognitive performance (reported elsewhere) was assessed using an extensive test battery; global cognitive functioning as assessed by the Mini-Mental State Examination (MMSE) is reported here. Longitudinal mixed-effects repeated-measures modeling was used to compare ECT plus medication and medication alone for efficacy and global cognitive function outcomes. Results: At 24 weeks, the ECT plus medication group had statistically significantly lower HAM-D scores than the medication only group. The difference in adjustedmean HAM-D scores at study end was 4.2 (95% CI=1.6, 6.9). Significantly more patients in the ECT plus medication group were rated "not ill at all" on the CGI-S compared with the medication only group. There was no statistically significant difference between groups in MMSE score. Conclusions: Additional ECT after remission (here operationalized as four continuation ECT treatments followed by furtherECTonly as needed)wasbeneficial in sustainingmood improvement for most patients.

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