Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study

CORE/PRIDE Work Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVE: There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study.

METHODS: Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05.

RESULTS: A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest.

CONCLUSION: This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.

Original languageEnglish (US)
JournalAmerican Journal of Geriatric Psychiatry
DOIs
StateE-pub ahead of print - Oct 12 2019
Externally publishedYes

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Electroconvulsive Therapy
Geriatrics
Depression
Major Depressive Disorder
Episodic Memory
Venlafaxine Hydrochloride
Seizures
Drug Therapy

Cite this

@article{e9f76e8cfc8b40f19745dffee8a0318b,
title = "Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study",
abstract = "OBJECTIVE: There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study.METHODS: Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05.RESULTS: A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest.CONCLUSION: This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.",
author = "{CORE/PRIDE Work Group} and Lisanby, {Sarah H} and McClintock, {Shawn M} and George Alexopoulos and Bailine, {Samuel H} and Elisabeth Bernhardt and Briggs, {Mimi C} and Cullum, {C Munro} and Zhi-De Deng and Mary Dooley and Geduldig, {Emma T} and Greenberg, {Robert M} and Husain, {Mustafa M} and Styliani Kaliora and Knapp, {Rebecca G} and Vassilios Latoussakis and Liebman, {Lauren S} and McCall, {William V} and Martina Mueller and Georgios Petrides and Joan Prudic and Rosenquist, {Peter B} and Rudorfer, {Matthew V} and Shirlene Sampson and Teklehaimanot, {Abeba A} and Tobias, {Kristen G} and Weiner, {Richard D} and Young, {Robert C} and Kellner, {Charles H}",
note = "Copyright {\circledC} 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = "10",
day = "12",
doi = "10.1016/j.jagp.2019.10.003",
language = "English (US)",
journal = "American Journal of Geriatric Psychiatry",
issn = "1064-7481",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression

T2 - Phase 1 of the PRIDE Study

AU - CORE/PRIDE Work Group

AU - Lisanby, Sarah H

AU - McClintock, Shawn M

AU - Alexopoulos, George

AU - Bailine, Samuel H

AU - Bernhardt, Elisabeth

AU - Briggs, Mimi C

AU - Cullum, C Munro

AU - Deng, Zhi-De

AU - Dooley, Mary

AU - Geduldig, Emma T

AU - Greenberg, Robert M

AU - Husain, Mustafa M

AU - Kaliora, Styliani

AU - Knapp, Rebecca G

AU - Latoussakis, Vassilios

AU - Liebman, Lauren S

AU - McCall, William V

AU - Mueller, Martina

AU - Petrides, Georgios

AU - Prudic, Joan

AU - Rosenquist, Peter B

AU - Rudorfer, Matthew V

AU - Sampson, Shirlene

AU - Teklehaimanot, Abeba A

AU - Tobias, Kristen G

AU - Weiner, Richard D

AU - Young, Robert C

AU - Kellner, Charles H

N1 - Copyright © 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

PY - 2019/10/12

Y1 - 2019/10/12

N2 - OBJECTIVE: There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study.METHODS: Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05.RESULTS: A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest.CONCLUSION: This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.

AB - OBJECTIVE: There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study.METHODS: Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05.RESULTS: A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest.CONCLUSION: This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.

U2 - 10.1016/j.jagp.2019.10.003

DO - 10.1016/j.jagp.2019.10.003

M3 - Article

C2 - 31706638

JO - American Journal of Geriatric Psychiatry

JF - American Journal of Geriatric Psychiatry

SN - 1064-7481

ER -