Right unilateral ultrabrief pulse ECT in geriatric depression

Phase 1 of the PRIDE study

CORE/PRIDE Work Group

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Objective: The Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy of right unilateral ultrabrief pulse electroconvulsive therapy (ECT) combined with venlafaxine for the treatment of geriatric depression. Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, combined with open-label venlafaxine at seven academic medical centers. In phase 2 (reported separately), patientswho had remitted were randomly assigned to receive pharmacotherapy (venlafaxine plus lithium) or pharmacotherapy plus continuation ECT. In phase 1, depressed patients received high-dose ECT (at six times the seizure threshold) three times per week. Venlafaxine was started during the first week of treatment and continued throughout the study. The primary outcome measure was remission, assessed with the 24-item Hamilton Depression Rating Scale (HAM-D), which was administered three times per week. Secondary outcome measures were post-ECT reorientation and safety. Paired t tests were used to estimate and evaluate the significance of change from baseline in HAM-D scores. Results: Of 240 patients who entered phase 1 of the study, 172 completed it. Overall, 61.7% (148/240) of all patients met remission criteria, 10.0% (24/240) did not remit, and 28.3% (68/ 240) dropped out; 70% (169/240)met response criteria. Among those who remitted, the mean decrease in HAM-D score was 24.7 points (95% CI=23.4, 25.9), with a mean final score of 6.2 (SD=2.5) and an average change from baseline of 79%. The mean number of ECT treatments to remission was 7.3 (SD=3.1). Conclusions: Right unilateral ultrabrief pulse ECT, combined with venlafaxine, is a rapidly acting and highly effective treatment option for depressed geriatric patients, with excellent safety and tolerability. These data add to the evidence base supporting the efficacy of ECT to treat severe depression in elderly patients.

Original languageEnglish (US)
Pages (from-to)1101-1109
Number of pages9
JournalAmerican Journal of Psychiatry
Volume173
Issue number11
DOIs
StatePublished - Nov 1 2016

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Electroconvulsive Therapy
Geriatrics
Depression
Outcome Assessment (Health Care)
Safety
Drug Therapy
Therapeutics
Lithium
Seizures
Venlafaxine Hydrochloride

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Right unilateral ultrabrief pulse ECT in geriatric depression : Phase 1 of the PRIDE study. / CORE/PRIDE Work Group.

In: American Journal of Psychiatry, Vol. 173, No. 11, 01.11.2016, p. 1101-1109.

Research output: Contribution to journalArticle

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title = "Right unilateral ultrabrief pulse ECT in geriatric depression: Phase 1 of the PRIDE study",
abstract = "Objective: The Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy of right unilateral ultrabrief pulse electroconvulsive therapy (ECT) combined with venlafaxine for the treatment of geriatric depression. Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, combined with open-label venlafaxine at seven academic medical centers. In phase 2 (reported separately), patientswho had remitted were randomly assigned to receive pharmacotherapy (venlafaxine plus lithium) or pharmacotherapy plus continuation ECT. In phase 1, depressed patients received high-dose ECT (at six times the seizure threshold) three times per week. Venlafaxine was started during the first week of treatment and continued throughout the study. The primary outcome measure was remission, assessed with the 24-item Hamilton Depression Rating Scale (HAM-D), which was administered three times per week. Secondary outcome measures were post-ECT reorientation and safety. Paired t tests were used to estimate and evaluate the significance of change from baseline in HAM-D scores. Results: Of 240 patients who entered phase 1 of the study, 172 completed it. Overall, 61.7{\%} (148/240) of all patients met remission criteria, 10.0{\%} (24/240) did not remit, and 28.3{\%} (68/ 240) dropped out; 70{\%} (169/240)met response criteria. Among those who remitted, the mean decrease in HAM-D score was 24.7 points (95{\%} CI=23.4, 25.9), with a mean final score of 6.2 (SD=2.5) and an average change from baseline of 79{\%}. The mean number of ECT treatments to remission was 7.3 (SD=3.1). Conclusions: Right unilateral ultrabrief pulse ECT, combined with venlafaxine, is a rapidly acting and highly effective treatment option for depressed geriatric patients, with excellent safety and tolerability. These data add to the evidence base supporting the efficacy of ECT to treat severe depression in elderly 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 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 Gail Reiter and Youssef, {Nagy Adel}",
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TY - JOUR

T1 - Right unilateral ultrabrief pulse ECT in geriatric depression

T2 - Phase 1 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 - 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 - Reiter, Gail

AU - Youssef, Nagy Adel

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Objective: The Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy of right unilateral ultrabrief pulse electroconvulsive therapy (ECT) combined with venlafaxine for the treatment of geriatric depression. Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, combined with open-label venlafaxine at seven academic medical centers. In phase 2 (reported separately), patientswho had remitted were randomly assigned to receive pharmacotherapy (venlafaxine plus lithium) or pharmacotherapy plus continuation ECT. In phase 1, depressed patients received high-dose ECT (at six times the seizure threshold) three times per week. Venlafaxine was started during the first week of treatment and continued throughout the study. The primary outcome measure was remission, assessed with the 24-item Hamilton Depression Rating Scale (HAM-D), which was administered three times per week. Secondary outcome measures were post-ECT reorientation and safety. Paired t tests were used to estimate and evaluate the significance of change from baseline in HAM-D scores. Results: Of 240 patients who entered phase 1 of the study, 172 completed it. Overall, 61.7% (148/240) of all patients met remission criteria, 10.0% (24/240) did not remit, and 28.3% (68/ 240) dropped out; 70% (169/240)met response criteria. Among those who remitted, the mean decrease in HAM-D score was 24.7 points (95% CI=23.4, 25.9), with a mean final score of 6.2 (SD=2.5) and an average change from baseline of 79%. The mean number of ECT treatments to remission was 7.3 (SD=3.1). Conclusions: Right unilateral ultrabrief pulse ECT, combined with venlafaxine, is a rapidly acting and highly effective treatment option for depressed geriatric patients, with excellent safety and tolerability. These data add to the evidence base supporting the efficacy of ECT to treat severe depression in elderly patients.

AB - Objective: The Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy of right unilateral ultrabrief pulse electroconvulsive therapy (ECT) combined with venlafaxine for the treatment of geriatric depression. Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, combined with open-label venlafaxine at seven academic medical centers. In phase 2 (reported separately), patientswho had remitted were randomly assigned to receive pharmacotherapy (venlafaxine plus lithium) or pharmacotherapy plus continuation ECT. In phase 1, depressed patients received high-dose ECT (at six times the seizure threshold) three times per week. Venlafaxine was started during the first week of treatment and continued throughout the study. The primary outcome measure was remission, assessed with the 24-item Hamilton Depression Rating Scale (HAM-D), which was administered three times per week. Secondary outcome measures were post-ECT reorientation and safety. Paired t tests were used to estimate and evaluate the significance of change from baseline in HAM-D scores. Results: Of 240 patients who entered phase 1 of the study, 172 completed it. Overall, 61.7% (148/240) of all patients met remission criteria, 10.0% (24/240) did not remit, and 28.3% (68/ 240) dropped out; 70% (169/240)met response criteria. Among those who remitted, the mean decrease in HAM-D score was 24.7 points (95% CI=23.4, 25.9), with a mean final score of 6.2 (SD=2.5) and an average change from baseline of 79%. The mean number of ECT treatments to remission was 7.3 (SD=3.1). Conclusions: Right unilateral ultrabrief pulse ECT, combined with venlafaxine, is a rapidly acting and highly effective treatment option for depressed geriatric patients, with excellent safety and tolerability. These data add to the evidence base supporting the efficacy of ECT to treat severe depression in elderly patients.

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