Electroconvulsive Therapy Can Reduce Depression and Prevent Relapse in Older Adults

Brain & Behavior Research Foundation | August 25, 2016

Sarah H. Lisanby, M.D. NNDC Executive Board Member

Electroconvulsive therapy (ECT) in combination with antidepressant medication rapidly relieves the symptoms of major depression in older adults, according to a recent clinical trial. What’s more, after depression symptoms have diminished, additional ECT can help sustain improvements in mood and prevent relapse.

The findings, reported July 15, 2016, in the American Journal of Psychiatry, come from theProlonging Remission in Depressed Elderly (PRIDE) study, which tested the effects of right unilateral ultrabrief ECT, a type of ECT designed to minimize cognitive side effects. Although some forms of ECT can cause memory problems, cognitive function remained stable for study participants during their treatments.

The study was co-led by Charles H. Kellner, MD at the Icahn School of Medicine at Mt. Sinai and Sarah H. Lisanby, M.D., the head of translational research at the National Institute of Mental Health, a 1996 NARSAD Young Investigator, 2003 Independent Investigator, 2010 Distinguished Investigator, and a recipient of the Klerman Prize in 2001. The team included:  2008 Young Investigator Shawn M. McClintock, Ph.D., at the University of Texas Southwestern Medical Center; 2009 Independent Investigator Joan Prudic, M.D., at Columbia University Medical Center; and 2010 Young Investigator, 1996 Young Investigator, 2003 Independent investigator, and 2010 Distinguished Investigator, and 2001 Klerman Prizewinner Styliani Christos Kaliora, M.D., at the Feinstein Institute for Medical Research also participated in the research.

Participants in the PRIDE study were between 60 and 89 years old. Of the 240 patients with severe depression who began the trial, 70 percent responded to an initial round of treatment, which involved three ECT treatments per week plus the antidepressant venlafaxine (Effexor), within four weeks. In 62 percent of trial participants, depression symptoms declined enough that patients’ depression reached remission.

Participants whose depression was in remission following this initial phase of the PRIDE trial were eligible to participate in a second phase, designed to assess whether additional ECT could keep depression symptoms at bay. Phase 2 of the trial involved 120 patients, who received either ECT plus antidepressant medication (venlafaxine and lithium) or medication alone. Those who received ECT had four treatments during the first month, then additional treatments as needed according to each patient’s symptoms.

After 24 weeks, depression symptoms were significantly lower in patients who received additional ECT after the acute course than in those who received medication alone. Fewer patients in the ECT plus medication group had relapsed. Among those whose depression did return, relapse occurred more quickly in patients receiving medication alone than it did in patients who also received ECT. At the end of the trial, patients in the ECT plus medication group were 5.2 times more likely than those who received medication alone to be considered “not at all ill.”