Influence of age on the efficacy of electroconvulsive therapy in major depression: A retrospective study

Birkenhäger, Tom K.; Pluijms, Esther M.; Ju, M. R.; Mulder, Paul; Broek, Walter W. van den

doi:10.1016/j.jad.2010.02.131

Cited by 31 publications

(15 citation statements)

References 17 publications

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“…Furthermore, a large age range (23-81 yr) of the present sample including elderly patients has to be acknowledged with a significantly better response to ECT in older patients, which is in line with a multi-site longitudinal study (CORE) showing older age to confer a greater likelihood of achieving remission under ECT (O'Connor et al 2001) and another study reporting even the oldest depressed patients to respond to ECT equally well or even better than younger patients (Tew et al 1999). However, several other studies failed to demonstrate an influence of age on ECT effectiveness (Birkenhäger et al 2010 ;Damm et al 2010). Finally, taking into account the OR usually found by pharmacogenetic studies in major depression, the power of the present study to detect associations with remission is quite low.…”

Section: Discussioncontrasting

confidence: 58%

Dopamine D3 receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression

Dannlowski

Domschke

Birosova

et al. 2013

International Journal of Neuropsychopharmacology

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Dysfunction of dopamine D₃ receptors, particularly in the mesocorticolimbic system, has been linked to the pathogenesis of major depression. Preclinical data show enhanced D₃ receptor binding in the striatum upon antidepressant medication and electroconvulsive therapy (ECT). Thus, the potential impact of dopamine D₃ receptor gene (DRD3) variation on ECT outcome in treatment-resistant major depression was evaluated by applying a combined molecular and imaging genetic approach. Altogether, 10 representative variants covering 95.4% of DRD3 gene variation were investigated for association with response to ECT in a sample of 104 (71 female, 33 male) Caucasian patients with pharmacorefractory major depression. Additionally, ventral striatum responsiveness to happy faces was assessed in two independent samples of depressed patients (total N=54) by means of functional magnetic resonance imaging at 3 T. Significant association of DRD3 rs3732790, rs3773679 and rs9817063 variants with response (uncorrected p=0.02-0.03) and remission (uncorrected p=0.01) after ECT was discerned. Logistic regression analyses revealed association of rs3732790 (uncorrected p=0.009; corrected p=0.045) and rs3773679 (uncorrected p=0.009; corrected p=0.045) with remission when applying a recessive model of inheritance. The rs3732790T allele conferring a more favourable treatment response was furthermore found to be associated with stronger striatal responsiveness to happy facial expressions (sample 1: cluster-corrected p=0.002; sample 2: p=0.023). In summary, the present study suggests some impact of DRD3 gene variation on ECT response, potentially mediated by alteration of striatal engagement during the processing of emotionally rewarding stimuli.

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Section: Discussioncontrasting

confidence: 58%

Dopamine D3 receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression

Dannlowski

Domschke

Birosova

et al. 2013

International Journal of Neuropsychopharmacology

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“…Not all studies report age as a predictor to response to ECT . Nevertheless ECT is a favored treatment among the elderly, in part because of its efficacy and their poor response and poor tolerance to known medications.…”

Section: Resultsmentioning

confidence: 99%

What was learned: studies by the consortium for research inECT(CORE) 1997–2011

Fink

2014

Acta Psychiatr Scand

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Objective: To review the findings of the four-hospital collaborative studies of electroconvulsive therapy (ECT) in unipolar depressed patients known as CORE between 1997 and 2011. Unipolar depressed patients were treated with bilateral ECT, and on remission were randomly assigned to a fixed schedule continuation ECT or to combined lithium and nortriptyline for 6 months. A second study compared three electrode placements in unipolar and bipolar depressed patients. Method: Nineteen published reports were reviewed. The findings are compared with those of a parallel multi-hospital study of ECT led by a Columbia University Collaboration (CUC) team that studied right unilateral ECT in a similar population with similar inclusion/exclusion and remission criteria. Successful ECT was followed by placebo, nortriptyline alone, or combined lithium, and nortriptyline. Results: Relapse rates after remission were similar with fixed schedule ECT as with medications. Predictors of outcome (psychosis, suicide risk, polarity, melancholia, atypical depression, age) and technical aspects (electrode placement, seizure threshold, speed of response) are discussed, Conclusion: The findings offer criteria to optimize the selection of patients, the technique, and outcome of ECT for unipolar and bipolar depressed patients. Continuation ECT is an effective alternative to continuation treatment with lithium and nortriptyline. Bilateral electrode placement is more efficient than alternative placements. ECT relieves both bipolar and unipolar depression. M. FinkDepartments of Psychiatry and Neurology, Stony Brook University, Long Island, NY, USA Summation• Continuation treatments, either continuation electroconvulsive therapy (ECT) or combined nortriptyline and lithium, sustain 6-month remission rates equally after successful courses of ECT in depressed patients.• Unipolar and bipolar depressive mood disordered patients are relieved equally by ECT.• ECT with bitemporal electrode placement is more efficient than treatment with right unilateral placement.• Seizure threshold determinations to determine electricity dosing are neither necessary nor useful for effective ECT.• ECT rapidly relieves active suicide risk. Consideration• A prescribed fixed treatment schedule for continuation ECT was inefficient. A flexible "as required by symptoms" schedule would have improved outcomes.• Determining the seizure threshold in the first treatment unnecessarily reduced the efficiency of the treatment course. Seizure threshold (ST) calibration is not needed for effective dosing.• Failure to examine neuroendocrine measures during the study lost an opportunity for greater understanding of the mechanism of action of ECT.'This paper is commented on by Tom G. Bolwig (Acta Psyciatr Scand 2014;129:415-416.)'

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“…70 (For more on antidepressants and possible adverse effects, see Table 1. 76 The newest treatment offered for treatment of depression is repetitive (or rapid-rate) transcranial magnetic stimulation (rTMS), which uses magnetic fields to stimulate the prefrontal cortex. 73,74 Early discontinuation can result in ineffective treatment and recurrence.…”

Section: Psychosocial Interventions and Psychotherapymentioning

confidence: 99%

Depression in Older Adults

Cahoon¹

2012

AJN, American Journal of Nursing

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Depression affects an estimated 15% to 19% of Americans ages 65 and older living in a variety of settings, yet the illness often goes unrecognized and untreated. Known risk factors for older adults include having chronic medical conditions, physical or cognitive functional decline, polypharmacy, experiencing multiple losses, and social isolation. There are brief screening tools that have proven effective in this population, and once recognized, depression is highly treatable. This article describes the signs and symptoms common in older adults, outlines several types of depressive disorders, discusses screening tools, describes treatment modalities, and addresses nursing implications.

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Influence of age on the efficacy of electroconvulsive therapy in major depression: A retrospective study

Cited by 31 publications

References 17 publications

Dopamine D3 receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression

Dopamine D3 receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression

What was learned: studies by the consortium for research inECT(CORE) 1997–2011

Depression in Older Adults

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