Addition of L‐tryptophan to electroconvulsive treatment in endogenous depression

Abstract

The combination of electroconvulsive treatment (ECT) and i.v. L-tryptophan (T) was compared with ECT and saline in double-blind study comprising 20 patients with endogenous depression. No significant difference was found with regard to the number of ECT given nor in the rate of reduction of depressive symptoms. Except for a slight decrease of plasma total tryptophan in the palcepo group, no difference were found in plasma total and free tryptophan nor in the concentration of total tryptophan in the cerebrospinal fluid.

The impact of electroconvulsive therapy on the tryptophan–kynurenine metabolic pathway

“…Previous research demonstrated no alteration in TRP concentrations after a single or a course of repetitive ECT (Kirkegaard et al, 1978;Mokhtar et al, 1997;Whalley et al, 1980), whereas Palmio et al found an increase in TRP concentrations 2-24 h after a single ECT session (Palmio et al, 2005). Another study demonstrated lower TRP concentration and TRP availability after a course of repetitive ECT particularly in ECT responders (Hoekstra et al, 2001).…”

Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies

“…54,55 None of 13 trials examining the efficacy of adjunctive or continuation pharmacotherapy adequately described the method of randomisation. Seven of these trials were double blind, [59][60][61]63,[66][67][68] four were single blind 57,58,62,64 and in two it was not clear whether the clinician or the patient was blind to treatment allocation. 56,65 One RCT examining the impact of the educational video on patient knowledge 69 used concealed randomisation, but was not blind and only measured knowledge at follow-up using an instrument with no evidence to support its psychometric properties.…”

“…Two trials compared unilateral ECT combined with L-tryptophan versus unilateral ECT and placebo. 59,60 Three trials compared ECT combined with imipramine versus ECT combined with placebo. 61,62,65 In one study the dosage of imipramine ranged from 25 to 50 mg, 61 in another the dosage was 25 mg three times daily 62 and in the third it ranged from 150 to 220 mg. 65 Imlah and colleagues 62 also had an arm in the trial where ECT was combined with phenelzine (15 mg three times daily).…”

“…In the remaining four trials, the length of ECT treatment was unclear. 56,59,63,66 In five of the trials, participants continued to take the pharmacotherapy they had been randomised to after ECT treatment and were followed up at 3 months, 63 In the Arfwidsson trial 58 there was a nonsignificant trend for people treated with ECT plus chlorpromazine to be more likely to have improved than people treated with ECT and placebo (RR = 1.13, 95% CI 0.88 to 1.46, n = 52). Shiah and colleagues 57 also found a nonsignificant trend for people treated with pindolol to have responded after six ECTs compared with those treated with placebo (RR = 10.8, 95% CI 0.66 to 177.33, p = 0.1, n = 20).…”

“…In populations with depressive illness, the reviewers identified two RCTs comparing ECT with rTMS 54,55 and ten RCTs comparing ECT combined with drug treatment versus ECT combined with either placebo or a different drug. [56][57][58][59][60][61][62][63][64][65] In four of these trials, [61][62][63][64] participants continued taking pharmacotherapy following the course of ECT and its impact on relapses was assessed. The search also found three trials [66][67][68] that compared different approaches to antidepressant treatment following successful treatment with ECT.…”