oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Continuation electroconvulsive therapy with pharmacotherapy versus pharmacotherapy alone for prevention of relapse of depression: A Randomized Controlled Trial
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.ORCID iD: 0000-0001-7454-3065
Örebro City Council, Psychiatry Research Center, Örebro, Sweden.
Psychiatry Clinic, Falun Hospital, Sweden.
Karolinska Institute, Dept Clinical Neuroscience, Stockholm, Sweden; Danderyd Hospital, Stockholm, Sweden .
Show others and affiliations
2013 (English)In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 29, no 2, p. 86-92Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The primary aim of the study was to test the hypothesis that relapse prevention with continuation electroconvulsive therapy (ECT) plus pharmacotherapy is more effective than pharmacotherapy alone after a course of ECT for depression.

METHODS: A multicenter, nonblinded, randomized controlled trial with 2 parallel groups was performed from 2008 to 2012 in 4 hospitals in Sweden. Patients eligible had unipolar or bipolar depression and had responded to a course of ECT. The patients (n = 56) were randomly assigned (1:1) to receiving either 29 treatments of continuation ECT with pharmacotherapy or pharmacotherapy alone for 1 year. The pharmacotherapy consisted of antidepressants (98%), lithium (56%), and antipsychotics (30%). The main outcome was relapse of depression within 1 year. Relapse was defined as 20 or more points on the Montgomery Åsberg Depression Rating Scale or inpatient psychiatric care or suicide or suspected suicide. All 56 patients randomized were analyzed according to an intention to treat analysis.

RESULTS: Sixty-one percent of the patients treated with pharmacotherapy versus 32% of the patients treated with ECT plus pharmacotherapy relapsed within 1 year (P = 0.036). The Cox proportional hazard ratio was 2.32 (1.03-5.22).Cognitive function and memory measures were stable for patients without relapse in both groups.One suspected suicide and 3 suicide attempts by intoxication occurred, all in the pharmacotherapy-alone group.

CONCLUSIONS: The post-ECT relapse rates were substantial in both treatment groups with a statistically significant advantage for combined treatment with pharmacotherapy and continuation ECT. Further studies are needed to define indications for continuation ECT, pharmacotherapy, and their combination.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2013. Vol. 29, no 2, p. 86-92
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-27585DOI: 10.1097/YCT.0b013e318276591fISI: 000319457700012PubMedID: 23303421Scopus ID: 2-s2.0-84880136961OAI: oai:DiVA.org:oru-27585DiVA, id: diva2:605828
Note

Funding agency:

Uppsala-Örebro Regional Research Council

Research Committee of Örebro County Council  

Available from: 2013-02-15 Created: 2013-02-15 Last updated: 2018-05-17Bibliographically approved
In thesis
1. Electroconvulsive therapy for depression
Open this publication in new window or tab >>Electroconvulsive therapy for depression
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overarching aims of the thesis were to identify clinical characteristics that predict the outcomes of depressed patients treated inclinical practice by ECT, and to elucidate the effectiveness of continuation ECT at preventing relapses and recurrences.

Methods: The studies included a retrospective chart review, three studies based on a quality register for ECT, and a randomized controlled trial(RCT) examining the effectiveness of continued ECT.

Results: The overall response rate to ECT was 80%. Patients with psychotic depression (89%), older patients (84%), and inpatients (83%) had the highest response rates. Patients with personality disorders (66%) and outpatients (66%) had the lowest response rates. With regard to patients on sick leave, 59%, 71% and 88% of patients regained occupational functioning 6, 12 and 24 months after ECT, respectively. The rate of hospitalisation after ECT was high, with rates of 25%, 34%and 44% 6, 12 and 24 months after ECT, respectively. The relapse rate was higher in patients that were taking benzodiazepines and lower in patients that were taking lithium.

The relapse rate was significantly lower in patients treated with continued ECT in combination with pharmacotherapy (32%) than in those treated with pharmacotherapy alone (61%). This difference was particularly pronounced in medication-resistant patients (31% vs. 85%)

Conclusions: The short-term response rate to ECT is relatively high in all patient subgroups, and is particularly high in older patients, inpatients and patients with severe depression. Patients often regain occupational functioning after ECT; however, this takes a considerably longer time than that required for symptom relief. Nevertheless, the relapse and recurrence rates of patients are high in the years after ECT. Continuation ECT and lithium treatment can be combined with antidepressants to reduce the risk of relapse and recurrence. Further RCTs are required to define the indications for continuation ECT and lithium treatment.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 89
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 85
Keywords
electroconvulsive therapy, mood disorders, depressive disorder, major, bipolar disorder, treatment outcome, recurrence
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-28663 (URN)978-91-7668-932-5 (ISBN)
Public defence
2013-05-24, Bohmanssonsalen Universitetssjukhuset, Södra Grev Rosengatan, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-11 Created: 2013-04-11 Last updated: 2017-10-17Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMedScopus

Authority records BETA

Nordenskjöld, AxelEngström, Ingemar

Search in DiVA

By author/editor
Nordenskjöld, AxelEngström, Ingemar
By organisation
School of Health and Medical Sciences, Örebro University, SwedenÖrebro University Hospital
In the same journal
Journal of ECT
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 623 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf