Combination of Pharmacotherapy With Electroconvulsive Therapy in Prevention of Depressive Relapse

Yıldız, Ayşegül; Mantar, Atıl; Şimşek, Selçuk; Onur, Elif; Gökmen, Ali Necati; Fidaner, Hüray

doi:10.1097/yct.0b013e3181c189f7

Cited by 28 publications

(11 citation statements)

References 25 publications

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“…Another approach would be to start study medication prior to ECT, thereby maybe reducing the risk of early relapse and making the design more acceptable for patients and clinicians. This is supported by the study by Yildiz et al [23] who found a significant reduction in relapse when trial medication was started early compared to later in the ECT course but not by the study by Prudic et al [24], who found no difference in relapse rates when pharmacotherapy was started before or after ECT. However, if patients are randomised before remission has been obtained, the outcome of the post-randomisation acute treatment needs to be taken into account.…”

supporting

confidence: 75%

Relapse Prevention in Major Depressive Disorder After Successful Acute Electroconvulsive Treatment: a 6-month Double-blind Comparison of Three Fixed Dosages of Escitalopram and a Fixed Dose of Nortriptyline – Lessons from a Failed Randomised Trial of the Danish University Antidepressant Group (DUAG-7)

et al. 2015

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lithium reduced the risk of relapse to 60 % and 39 %, respectively [5]. In the present study we aimed at investigating a potential dose-effect relationship regarding relapse prevention, by comparing daily dosages of escitalopram 10 mg, 20 mg and 30 mg, and additionally we compared these regimens with a daily dosage of 100 mg nortriptyline, which is generally considered an effective target dose in the treatment of acute depression. A dose range was chosen for escitalopram but not for nortriptyline, since escitalopram was the primary focus, whereas nortriptyline was our reference. Unfortunately, the planned sample size was not achieved, and therefore this report also addresses design issues having an impact on study feasibility, which might be of importance for future research in the field. Methods ▼ OrganisationThis study was carried out within the Danish University Antidepressant Group (DUAG), [6]. Introduction ▼Clinical practice and several randomised controlled studies have shown that a considerable proportion of patients with severe depression treated with electroconvulsive treatment (ECT) achieve remission after 8-12 treatment sessions over a period of 3-4 weeks [1]. However, the risk of relapse/recurrence is high in the following months. In a recent meta-analysis, the risk of relapse was estimated to be around 40 % in a 6 month period after ECT [2]. The evidence on relapse preventing efficacy of antidepressant medication after ECT is sparse regarding choice of drugs and dosage [3]. In a randomised controlled prevention study covering a 25-week period after ECT, patients treated with paroxetine had a significantly lower risk of relapse (10 % relapse) than patients treated with imipramine (30 % relapse) and placebo (65 % relapse) [4]. In a subsequent prevention study it was shown that 84 % of subjects in remission after ECT relapsed on placebo drug treatment over a 25-week period, while treatment with nortriptyline and the combination of nortriptyline and is an effective treatment for severe depression but carries a risk of relapse in the following months. Methods: Major depressive disorder patients in a current episode attaining remission from ECT (17-item Hamilton Depression Rating Scale (HAM-D 17 ) score ≤ 9) received randomly escitalopram 10 mg, 20 mg, 30 mg or nortriptyline 100 mg as monotherapies and were followed for 6 months in a multicentre double-blind set-up. Primary endpoint was relapse (HAM-D 17 ≥ 16). Results: As inclusion rate was low the study was prematurely stopped with only 47 patients

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supporting

confidence: 75%

Relapse Prevention in Major Depressive Disorder After Successful Acute Electroconvulsive Treatment: a 6-month Double-blind Comparison of Three Fixed Dosages of Escitalopram and a Fixed Dose of Nortriptyline – Lessons from a Failed Randomised Trial of the Danish University Antidepressant Group (DUAG-7)

et al. 2015

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“…Three RCTs (Lauritzen et al, 1996;Sackeim et al, 2001;Yildiz et al, 2010) provided extractable data at 3 months and seven (Imlah et al, 1965;Kay et al, 1970;Krog-Meyer et al, 1984;Lauritzen et al, 1996;Sackeim et al, 2001;Seager and Bird, 1962;van den Broek et al, 2006) at 6 months. Relapse rates were 62.7% (95% CI ¼ 47.6-75.8%, I 2 ¼ 0) at 3 months and 65.5% (95% CI ¼ 49.7-78.5%, I 2 ¼ 72%) at 6 months.…”

Section: Relapse Rates In Untreated Samplesmentioning

confidence: 99%

“…For the 3-month follow-up, three placebo-controlled RCTs (N ¼ 128) provided extractable data: two (Lauritzen et al, 1996;Yildiz et al, 2010) evaluating selective serotonin reuptake inhibitor (SSRI) monotherapy vs placebo and the other (Sackeim et al, 2001) comparing TCA monotherapy and TCA-lithium combination to placebo. The first Figure 3 Outcomes at 3, 12, and 24 months following ECT.…”

Section: Rr Of Relapse On Continuation Antidepressant Pharmacotherapymentioning

confidence: 99%

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

Jelovac

Kolshus

McLoughlin

2013

Neuropsychopharmacol

221

155

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High rates of early relapse following electroconvulsive therapy (ECT) are typically reported in the literature. Current treatment guidelines offer little information to clinicians on the optimal nature of maintenance therapy following ECT. The aim of this study was to provide a systematic overview of the existing evidence regarding post-ECT relapse. A keyword search of electronic databases was performed for studies appearing in the peer-reviewed literature before January 2013 reporting on relapse rates in responders to an acute course of ECT administered for a major depressive episode. Meta-analyses were performed where appropriate. Thirty-two studies with up to 2 years' duration of follow-up were included. In modern era studies of continuation pharmacotherapy, 51.1% (95% CI ¼ 44.7-57.4%) of patients relapsed by 12 months following successful initial treatment with ECT, with the majority (37.7%, 95% CI ¼ 30.7-45.2%) relapsing within the first 6 months. The 6-month relapse rate was similar in patients treated with continuation ECT (37.2%, 95% CI ¼ 23.4-53.5%). In randomized controlled trials, antidepressant medication halved the risk of relapse compared with placebo in the first 6 months (risk ratio ¼ 0.49, 95% CI ¼ 0.39-0.62, po0.0001, number needed to treat ¼ 3.3). Despite continuation therapy, the risk of relapse within the first year following ECT is substantial, with the period of greatest risk being the first 6 months. The largest evidence base for efficacy in post-ECT relapse prevention exists for tricyclic antidepressants. Published evidence is limited or non-existent for commonly used newer antidepressants or popular augmentation strategies. Maintenance of well-being following successful ECT needs to be improved.

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“…A double-blind, placebo, controlled trial found that early pharmacotherapy with sertraline provided protection against relapse, with a relapse rate of only 14% (Yildiz et al, 2010). Nortriptyline plus lithium has also been suggested as a useful combination therapy to prevent relapse following ECT (Sackeim et al, 2001), though ultimately the optimal therapy is likely to be determined at an individual level.…”

Section: Does Ect Prevent Relapse?mentioning

confidence: 99%

The Use of ECT and MST in treating depression

Allan

Ebmeier

2011

International Review of Psychiatry

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Electroconvulsive therapy (ECT) has been used clinically since 1938. Its most common use is in the treatment of depression: fi rst line treatment where rapid recovery is a priority, but more frequently as an effective treatment for patients who do not respond to pharmacological and psychological approaches. Whilst it is widely hailed as an effective treatment, concerns about its effect on cognition remain. The development of magnetic seizure therapy (MST) over the past decade has attempted to devise a therapy with comparable effi cacy to ECT, but without the associated cognitive side effects. The rationale for this is that MST uses magnetic fi elds to induce seizures in the cortex, without electrical stimulation of brain structures involved with memory. MST has been used successfully in the treatment of depression, yet there is a dearth of literature in comparison with ECT. We present a systematic review of the literature on ECT (from 2009ECT (from -2011 and MST (from 2001MST (from -2011.

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Combination of Pharmacotherapy With Electroconvulsive Therapy in Prevention of Depressive Relapse

Abstract: Comparative efficacy of c-pharm early and late strategies in providing improved protection against post-ECT relapse of major depressive disorder needs to be further explored.

Cited by 28 publications

References 25 publications

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

The Use of ECT and MST in treating depression

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