The benefits and costs of changing treatment technique in electroconvulsive therapy due to insufficient improvement of a major depressive episode

Autor: Devangere P. Devanand, Mitchell S. Nobler, Joan Prudic, Harold A. Sackeim, William V. McCall, Benoit H. Mulsant, Roger F. Haskett, Peter B. Rosenquist
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Male
Pediatrics
medicine.medical_specialty
medicine.medical_treatment
Cost-Benefit Analysis
Switching strategy
Biophysics
Columbia university
Brief pulse
behavioral disciplines and activities
050105 experimental psychology
Article
law.invention
lcsh:RC321-571
03 medical and health sciences
0302 clinical medicine
Electroconvulsive therapy
Randomized controlled trial
law
Recurrence
mental disorders
medicine
Humans
0501 psychology and cognitive sciences
Relapse
Major depressive episode
Electroconvulsive Therapy
lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry
Aged
Depressive Disorder
Major
business.industry
General Neuroscience
05 social sciences
Therapeutic effect
Middle Aged
Antidepressive Agents
Treatment Outcome
Retrograde amnesia
Antidepressant
Female
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
Follow-Up Studies
Electroconvulsive therapy (ECT)
Zdroj: Brain Stimulation, Vol 13, Iss 5, Pp 1284-1295 (2020)
Brain Stimul
Popis: Background Electroconvulsive therapy (ECT) technique is often changed after insufficient improvement, yet there has been little research on switching strategies. Objective To document clinical outcome in ECT nonresponders who were received a second course using high dose, brief pulse, bifrontotemporal (HD BP BL) ECT, and compare relapse rates and cognitive effects relative to patients who received only one ECT course and as a function of the type of ECT first received. Methods Patients were classified as receiving Weak, Strong, or HD BP BL ECT during three randomized trials at Columbia University. Nonresponders received HD BP BL ECT. In a separate multi-site trial, Optimization of ECT, patients were randomized to right unilateral or BL ECT and nonresponders also received further treatment with HD BP BL ECT. Results Remission rates with a second course of HD BP BL ECT were high in ECT nonresponders, approximately 60% and 40% in the Columbia University and Optimization of ECT studies, respectively. Clinical outcome was independent of the type of ECT first received. A second course with HD BP BL ECT resulted in greater retrograde amnesia immediately, two months, and six months following ECT. Conclusions In the largest samples of ECT nonresponders studied to date, a second course of ECT had marked antidepressant effects. Since the therapeutic effects were independent of the technique first administered, it is possible that many patients may benefit simply from longer courses of ECT. Randomized trials are needed to determine whether, when, and how to change treatment technique in ECT.
Databáze: OpenAIRE
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