Electroconvulsive therapy vs. paroxetine in treatment‐resistant depression — a randomized study

Abstract

Failure to respond to adequate pharmacological treatment for major depression is now the most common indication for the use of electroconvulsive therapy (ECT). The advantages of ECT with respect to both speed and quality of response are clinically important issues, but surprisingly few studies have examined the efficacy of ECT in relation to newer antidepressant agents such as selective serotonin reuptake inhibitors (SSRIs). A total of 39 subjects with major depression and with at least two failed antidepressant trials (mean 4.9 trials) were randomized to either paroxetine treatment (n=18) or right unilateral (RUL) ECT (n=21). Up to the end of the study treatment we found a reduction in the HAMD score of 59% for the ECT group and of 29% for the paroxetine group (P<0.001 paired t-test). In the ECT group, 71% of subjects fulfilled the response criteria (at least a 50% decrease in total HAMD score). The present study found ECT to be superior to paroxetine in medication-resistant major depression, in terms of both degree and speed of response.

Plasma Concentrations of Neuroactive Steroids before and after Electroconvulsive Therapy in Major Depression

“…Up to now, ECT is the most effective somatic therapy, especially for severe treatment-resistant major depressive disorder (ECT-review group, 2003). Overall, a 20% better improvement in comparison to tricyclic antidepressants (TCA) and a 45% better improvement in comparison to monoaminooxidase inhibitors (MAOI) (Janicak et al, 1985), as well as a better improvement in comparison to the SSRI paroxetine (Folkerts et al, 1997), have been described. In addition, a more rapid improvement in comparison to pharmacotherapeutic approaches has been demonstrated ( ECT-review group, 2003;Prudic et al, 1996;Sackeim et al, 1993).…”

Influence of Val108/158Met COMT Gene Polymorphism on the Efficacy of Modified Electroconvulsive Therapy in Patients with Treatment Resistant Depression

“…At present, TRD is treated with anti-depressive drugs, psychological and electroconvulsive therapies [13,14]. The currently used drugs for TRD treatment mainly replenish the supply of brain neurotransmitters involved in the pathogensis of disease [14].…”

“…In fact, the treatment has been recognized to be the most effective with an efficacy of 60 % [13,14]. MECT involves the stimulation of brain with a small dose of electric current for a short duration to evoke an epileptic seizure.…”

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica

“…Using the MeSH with specific nosologies (depression, mania, schizophrenia) we found eight RCT about depression, [19][20][21]60,[75][76][77][78] one about mania 79 and four about schizophrenia. 25,26,80,81 The major objective of such studies was to assess the efficacy of ECT in the referred nosologies.…”