Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study

Lisanby, Sarah H.; McClintock, Shawn M.; Alexopoulos, George S.; Bailine, Samuel H.; Bernhardt, Elisabeth; Briggs, Mimi C.; Cullum, C. Munro; Deng, Zhi‐De; Dooley, Mary; Geduldig, Emma T.; Greenberg, Robert M.; Husain, Mustafa M.; Kaliora, Styliani; Knapp, Rebecca G.; Latoussakis, Vassilios; Liebman, Lauren S.; McCall, W. Vaughn; Mueller, Martina; Petrides, Georgios; Prudic, Joan; Rosenquist, Peter B.; Rudorfer, Matthew V.; Sampson, Shirlene; Teklehaimanot, Abeba; Tobias, Kristen G.; Weiner, Richard D.; Young, Robert C.; Kellner, Charles H.

doi:10.1016/j.jagp.2019.10.003

Cited by 35 publications

(27 citation statements)

References 55 publications

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“…One could argue that an improvement in cognitive performance mirrors an improvement of depression after ECT. We did not, however, find such an association, nor did several others [15, 21, 52]. Nevertheless, interpreting cognitive performance after ECT, the impact of the depressive status cannot be overlooked.…”

Section: Discussioncontrasting

confidence: 78%

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Neurocognitive functioning after electroconvulsive therapy in late‐life depression: A 4‐year prospective study

Obbels

Vansteelandt

Bouckaert

et al. 2020

Acta Psychiatr Scand

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Objective Despite the proven efficacy and safety of ECT, there is still concern about the possible cognitive side effects of ECT in older patients. In this study, we aimed to characterize the long‐term cognitive effects of ECT in patients with late‐life depression (LLD) from before the start until 4 years after the index ECT course. Methods Fourty one patients aged 55 years and older with a unipolar depression, referred for ECT, were included. The neuropsychological test battery was assessed prior to ECT, 6 months, 1 year, 2 years, 3 years, and 4 years after the last ECT session. Results We did not find any statistically significant cognitive changes from before the start to 4 years after ending the ECT course. Although we could not detect cognitive changes at group level, we found clinically important differences on an individual level. Conclusion Cognitive performance in patients with LLD runs a stable course from before the start of ECT until 4 years after the index course. At an individual level, however, both cognitive decline and improvement can be witnessed. Older patients can tolerate ECT and most of them will not experience long‐term cognitive side effects.

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Section: Discussioncontrasting

confidence: 78%

“…The recent PRIDE study [15], however, demonstrated only minor acute cognitive side effects in 240 LLD patients, aged 60 or higher. These data confirm the conclusions of three earlier reviews: cognitive effects of ECT in LLD are limited and transient [16–18].…”

Section: Introductionmentioning

confidence: 99%

Neurocognitive functioning after electroconvulsive therapy in late‐life depression: A 4‐year prospective study

Obbels

Vansteelandt

Bouckaert

et al. 2020

Acta Psychiatr Scand

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“…Despite concerns about negative effects on cognitive functioning, such effects of ECT in geriatric depression were temporary and limited, with improved cognitive outcomes in unilateral ECT [ 31 ]. The PRIDE that investigated the neurocognitive effects of ECT in elderly patients with MDD demonstrated only phonemic fluency, complex visual scanning, and cognitive flexibility were qualitatively decreased from low average to mildly impaired [ 32 ]. Also, the course of dementia is not deteriorated due to ECT and comorbidities such as depression or agitation are indications of ECT [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

Recent Updates on Electro-Convulsive Therapy in Patients with Depression

Park

Kim

et al. 2021

Psychiatry Investig

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Objective Electro-convulsive therapy (ECT) has been established as a treatment modality for patients with treatment-resistant depression and with some specific subtypes of depression. This narrative review intends to provide psychiatrists with the latest findings on the use of ECT in depression, devided into total eight sub-topics.Methods We searched PubMed for English-language articles using combined keywords and tried to analyze journals published from 1995–2020.Results Pharmacotherapy such as antidepressants or maintenance ECT is more effective than a placebo as prevention of recurrence after ECT. The use of ECT in treatment-resistant depression, depressed patients with suicidal risks, elderly depression, bipolar depression, psychotic depression, and depression during pregnancy or postpartum have therapeutic benefits. As possible mechanisms of ECT, the role of neurotransmitters such as serotonin, dopamine, gamma-aminobutyric acid (GABA), and other findings in the field of neurophysiology, neuro-immunology, and neurogenesis are also supported.Conclusion ECT is evolving toward reducing cognitive side effects and maximizing therapeutic effects. If robust evidence for ECT through randomized controlled studies are more established and the mechanism of ECT gets further clarified, the scope of its use in the treatment of depression will be more expanded in the future.

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“…TRO is, however, evidenced by several studies to be one of the most sensitive to change with the type of seizure therapy/ECT intervention, as well as most predictive of CSEs [ 24 , 40 , 41 ]. Prior data from continuation treatments for at least six months would suggest a continued benign profile or even improvement of CSEs from acute course to continuation treatment with more intervals between sessions [ 11 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST)

et al. 2020

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Background: Concerns over cognitive side effects (CSE) of electroconvulsive therapy (ECT) still limit its broader usage for treatment-resistant depression (TRD). The objectives of this study were to (1) examine the CSE of Low Amplitude Seizure Therapy (LAP-ST) at 0.5 A compared to Ultra-brief Right Unilateral (UB-RUL) ECT using Time to Reorientation (TRO) as the main acute primary outcome, and (2) to compare effects on depressive symptoms between the two treatment groups. Methods: Participants were referred for ECT, consented for the study, and were randomized to a course of LAP-ST or standard UB-RUL ECT. TRO and depression were measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). Results: Eleven patients consented. Of these, eight with a current major depressive episode (MDE) of unipolar or bipolar disorders were randomized. TRO was faster for the LAP-ST (mean = 6.8 min; SE = 4.9) than standard RUL ECT (mean = 15.5 min; SE = 6.5). Depression improved similarly in the two arms of the study from baseline (MADRS: LAP-ST = 41.0; SE = 2.0, RUL = 39.0; SE = 3.8) to endpoint (MADRS score: LAP-ST = 8.0; SE7.2, RUL = 9.5; SE = 3.8). Conclusions: This pilot, randomized and blinded clinical trial, suggests that the LAP-ST (at 0.5 A) has faster reorientation and possibly lower CSE compared to standard RUL-UB ECT. Caution is advised in interpreting these results due to the small sample size of this pilot study. Thus, future studies with similar design are warranted for replicating these findings.

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Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study

Cited by 35 publications

References 55 publications

Neurocognitive functioning after electroconvulsive therapy in late‐life depression: A 4‐year prospective study

Neurocognitive functioning after electroconvulsive therapy in late‐life depression: A 4‐year prospective study

Recent Updates on Electro-Convulsive Therapy in Patients with Depression

Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST)

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