Health-related quality of life in a clinical trial of ECT followed by continuation pharmacotherapy: Effects immediately after ECT and at 24 weeks

William Vaughn McCall, Peter B. Rosenquist, James Kimball, Roger Haskett, Keith Isenberg, Joan Prudic, Barbara Lasater, Harold A. Sackeim

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

OBJECTIVE: To examine the determinants of health-related quality of life (HRQOL) immediately after a clinical trial of electroconvulsive therapy (ECT) for major depression and then again after 24 weeks of a continuation pharmacotherapy in a clinical trial comparing nortriptyline (NT) plus lithium (Li) versus venlafaxine (VEN) plus Li. METHOD: During acute ECT, 184 patients randomized to treatment with moderate-dosage bilateral (BL) ECT or high-dosage right unilateral (RUL) ECT completed the Medical Outcomes Study Short Form-36 (SF-36) as a measure of HRQOL before and immediately after ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN. Seventy-four of these met remission criteria and agreed to be further randomized to 24 more weeks of VEN + Li versus NT + Li for relapse prevention and completed a final SF-36. Cognitive testing was also completed. RESULTS: Scores from SF-36 were low before ECT, and the SF-36 subscales reflecting mental health were particularly low. Right unilateral electrode placement was associated with better SF-36 scores immediately after ECT, even after controlling for improvement in depression. Medication assignment during ECT (VEN, NT, or placebo) was not related to immediate HRQOL outcome, and cognitive performance was not related to immediate HRQOL. Remission immediately after ECT was associated with robust improvement in SF-36 scores compared with those who did not remit. Remission status remained a strong predictor of HRQOL 24 weeks after ECT, and sustained remitters showed additional gains in HRQOL 24 weeks after ECT. Electrode placement and medication assignment were not predictors at 24 weeks. CONCLUSIONS: Using state-of-the-art delivery of acute ECT and continuation antidepressant medication, HRQOL improves remarkably after ECT, and this improvement shows further gains with those persons who sustain remission. Health-related QOL is superior with RUL versus BL ECT in the immediate post-ECT period, but at 24-weeks HRQOL has absent or inconsistent relationship with mode of ECT delivery or type of continuation antidepressant pharmacotherapy.

Original languageEnglish (US)
Pages (from-to)97-102
Number of pages6
JournalJournal of ECT
Volume27
Issue number2
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

Fingerprint

Electroconvulsive Therapy
Quality of Life
Clinical Trials
Drug Therapy
Nortriptyline
Lithium
Antidepressive Agents
Electrodes
Placebos
Depression
Secondary Prevention

Keywords

  • depression
  • electroconvulsive therapy
  • electrode placement
  • health-related quality of life
  • lithium
  • memory
  • nortriptyline
  • placebo
  • stimulus dose
  • venlafaxine

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Neuroscience (miscellaneous)

Cite this

Health-related quality of life in a clinical trial of ECT followed by continuation pharmacotherapy : Effects immediately after ECT and at 24 weeks. / McCall, William Vaughn; Rosenquist, Peter B.; Kimball, James; Haskett, Roger; Isenberg, Keith; Prudic, Joan; Lasater, Barbara; Sackeim, Harold A.

In: Journal of ECT, Vol. 27, No. 2, 01.06.2011, p. 97-102.

Research output: Contribution to journalArticle

McCall, William Vaughn ; Rosenquist, Peter B. ; Kimball, James ; Haskett, Roger ; Isenberg, Keith ; Prudic, Joan ; Lasater, Barbara ; Sackeim, Harold A. / Health-related quality of life in a clinical trial of ECT followed by continuation pharmacotherapy : Effects immediately after ECT and at 24 weeks. In: Journal of ECT. 2011 ; Vol. 27, No. 2. pp. 97-102.
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