Pharmacological strategies in the prevention of relapse after electroconvulsive therapy

Joan Prudic, Roger F. Haskett, William Vaughn McCall, Keith Isenberg, Thomas Cooper, Peter B. Rosenquist, Benoit H. Mulsant, Harold A. Sackeim

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objective: To determine whether starting antidepressant medication at the start of electroconvulsive therapy (ECT) reduces post-ECT relapse and to determine whether continuation pharmacotherapy with nortriptyline (NT) and lithium (Li) differs in efficacy or adverse effects from continuation pharmacotherapy with venlafaxine (VEN) and Li. Methods: During an acute ECT phase, 319 patients were randomized to treatment with moderate dosage bilateral ECT or high-dosage right unilateral ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN. Of 181 patients to meet post-ECT remission criteria, 122 (67.4%) participated in a second continuation pharmacotherapy phase. Patients earlier randomized to NT or VEN continued on the antidepressant, whereas patients earlier randomized to placebo were now randomized to NT or VEN. Lithium was added for all patients who were followed until relapse or 6 months. Results: Starting an antidepressant medication at the beginning of the ECT course did not affect the rate or timing of relapse relative to starting pharmacotherapy after ECT completion. The combination of NT and Li did not differ from VEN and Li in any relapse or adverse effect measure. Older age was strongly associated with lower relapse risk, whereas the type of ECT administered in the acute phase and medication resistance were not predictive. Across sites, 50% of the patients relapsed, 33.6% continued in remission 6 months after ECT, and 16.4% dropped out. Conclusions: Starting an antidepressant medication during ECT does not affect relapse, and there are concerns about administering Li during an acute ECT course. Nortriptyline and VEN were equally effective in prolonging remission, although relapse rates after ECT are substantial despite intensive pharmacology. As opposed to the usual abrupt cessation of ECT, the impact of an ECT taper should be evaluated.

Original languageEnglish (US)
Pages (from-to)3-12
Number of pages10
JournalJournal of ECT
Volume29
Issue number1
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

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Electroconvulsive Therapy
Secondary Prevention
Pharmacology
Nortriptyline
Lithium
Recurrence
Antidepressive Agents
Drug Therapy
Placebos

Keywords

  • electroconvulsive therapy
  • lithium
  • nortriptyline
  • relapse prevention
  • venlafaxine

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Neuroscience (miscellaneous)

Cite this

Pharmacological strategies in the prevention of relapse after electroconvulsive therapy. / Prudic, Joan; Haskett, Roger F.; McCall, William Vaughn; Isenberg, Keith; Cooper, Thomas; Rosenquist, Peter B.; Mulsant, Benoit H.; Sackeim, Harold A.

In: Journal of ECT, Vol. 29, No. 1, 01.03.2013, p. 3-12.

Research output: Contribution to journalArticle

Prudic, Joan ; Haskett, Roger F. ; McCall, William Vaughn ; Isenberg, Keith ; Cooper, Thomas ; Rosenquist, Peter B. ; Mulsant, Benoit H. ; Sackeim, Harold A. / Pharmacological strategies in the prevention of relapse after electroconvulsive therapy. In: Journal of ECT. 2013 ; Vol. 29, No. 1. pp. 3-12.
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abstract = "Objective: To determine whether starting antidepressant medication at the start of electroconvulsive therapy (ECT) reduces post-ECT relapse and to determine whether continuation pharmacotherapy with nortriptyline (NT) and lithium (Li) differs in efficacy or adverse effects from continuation pharmacotherapy with venlafaxine (VEN) and Li. Methods: During an acute ECT phase, 319 patients were randomized to treatment with moderate dosage bilateral ECT or high-dosage right unilateral ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN. Of 181 patients to meet post-ECT remission criteria, 122 (67.4{\%}) participated in a second continuation pharmacotherapy phase. Patients earlier randomized to NT or VEN continued on the antidepressant, whereas patients earlier randomized to placebo were now randomized to NT or VEN. Lithium was added for all patients who were followed until relapse or 6 months. Results: Starting an antidepressant medication at the beginning of the ECT course did not affect the rate or timing of relapse relative to starting pharmacotherapy after ECT completion. The combination of NT and Li did not differ from VEN and Li in any relapse or adverse effect measure. Older age was strongly associated with lower relapse risk, whereas the type of ECT administered in the acute phase and medication resistance were not predictive. Across sites, 50{\%} of the patients relapsed, 33.6{\%} continued in remission 6 months after ECT, and 16.4{\%} dropped out. Conclusions: Starting an antidepressant medication during ECT does not affect relapse, and there are concerns about administering Li during an acute ECT course. Nortriptyline and VEN were equally effective in prolonging remission, although relapse rates after ECT are substantial despite intensive pharmacology. As opposed to the usual abrupt cessation of ECT, the impact of an ECT taper should be evaluated.",
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AU - McCall, William Vaughn

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AU - Cooper, Thomas

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