HIGHLIGHTS
- •What are the long-term neurocognitive effects of continuation treatment with ultra-brief pulse, 6 times seizure threshold, right unilateral ECT in combination with venlafaxine and lithium relative to only venlafaxine and lithium in older adults with major depressive disorder?
- •At the 6-month final time point, there were no statistically significant differences across all neurocognitive outcomes between the two treatment groups. Equally important, within each treatment group, there was statistically significant and qualitative improvement across most neuropsychological measures.
- •The combination of RUL-UB ECT with venlafaxine and lithium is a relatively tolerable and cognitively safe continuation treatment in late-life depression.
ABSTRACT
Objective
There is limited information regarding neurocognitive outcomes of right unilateral
ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy
in older adults with major depressive disorder. We report longitudinal neurocognitive
outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study.
Method
After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years
old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT
(STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A
comprehensive neuropsychological battery was administered at baseline and throughout
the 6-month treatment period. Statistical significance was defined as a p-value of
less than 0.05 (two-sided test).
Results
With the exception of processing speed, there was statistically significant improvement
across most neurocognitive measures from baseline to 6-month follow-up. There were
no significant differences between the two treatment groups at 6 months on measures
of psychomotor processing speed, autobiographical memory consistency, short-term and
long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning
and cognitive flexibility.
Conclusion
To our knowledge, this is the first report of neurocognitive outcomes over a 6-month
period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong
remission in older adults with major depression. Neurocognitive outcome did not differ
between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month
continuation treatment phase. These findings support the safety of RUL-UB ECT in combination
with pharmacotherapy in the prolonging of remission in late-life depression.
Key Words
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References
- Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication.Br J Psychiatry. 2015; 206: 67-71
Meyer JP, Swetter SK,Kellner CH: Electroconvulsive therapy in geriatric psychiatry: a selective review. Clin Geriatr Med 2020; 36:265–279
- Electroconvulsive therapy and age: age-related clinical features and effectiveness in treatment resistant major depressive episode.J Affect Disord. 2018; 227: 627-632
- Systematic review of cognitive effects of electroconvulsive therapy in late-life depression.Am J Geriatr Psychiatry. 2016; 24: 547-565
- Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy.J ECT. 2014; 30: 165-176
- The cognitive effects of electroconvulsive therapy in community settings.Neuropsychopharmacology. 2006; 32: 244-254
- A randomized controlled trial comparing the memory effects of continuation electroconvulsive therapy versus continuation pharmacotherapy: results from the Consortium for Research in ECT (CORE) Study.J Clin Psychiatry. 2010; 71: 185-193
- Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study.Int Psychogeriatr. 2014; 26: 315-324
- Neurocognitive effects of combined electroconvulsive therapy (ECT) and venlafaxine in geriatric depression: phase 1 of the PRIDE study.Am J Geriatr Psychiatry. 2020; 28: 304-316
- Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis.Biol Psychiatry. 2010; 68: 568-577
- A comparison between right unilateral ultrabrief electroconvulsive therapy and bilateral electroconvulsive therapy in the elderly: A pilot naturalistic observational study.Australas Psychiatry. 2018; 26: 394-397
- A comparison of RUL ultrabrief pulse (0.3 ms) ECT and standard RUL ECT.Int J Neuropsychopharmacol. 2008; 11: 883-890
- Predicting retrograde autobiographical memory changes following electroconvulsive therapy: relationships between individual, treatment, and early clinical factors.Int J Neuropsychopharmacol. 2015; 18: 1-8
- Bitemporal versus high-dose unilateral twice-weekly electroconvulsive therapy for depression (EFFECT-Dep): a pragmatic, randomized, non-inferiority trial.Am J Psychiatry. 2016; 173: 408-417
- Unilateral brief-pulse electroconvulsive therapy and cognition: effects of electrode placement, stimulus dosage and time.J Psychiatr Res. 2011; 45: 770-780
- A systematic review and meta-analysis of brief versus ultrabrief right unilateral electroconvulsive therapy for depression.J Clin Psychiatry. 2015; 76: 1092-1098
- Neurocognitive effects after brief pulse and ultrabrief pulse unilateral electroconvulsive therapy for major depression: a review.J Affect Disord. 2012; 140: 233-243
- Effect of concomitant pharmacotherapy on electrocovulsive therapy outcomes: Short-term efficacy and adverse effects.Arch Gen Psychiatry. 2009; 66: 729-737
- A novel strategy for continuation ECT in geriatric depression: phase 2 of the PRIDE Study.Am J Psychiatry. 2016; 173: 1110-1118
- Mini-Mental State": A practical method for grading the cognitive state of patients for clinicians.J Psychiatr Res. 1975; 12: 189-198
- MMSE changes during and after ECT in late-life depression: a prospective study.Am J Geriatr Psychiatry. 2019; 27: 934-944
- Usefulness of the Montreal Cognitive Assessment (MoCA) to monitor cognitive impairments in depressed patients receiving electroconvulsive therapy.Psychiatry Res. 2018; 259: 476-481
- Right unilateral ultrabrief pulse ECT in geriatric depression: Phase 1 of the PRIDE Study.Am J Psychiatry. 2016; 173: 1101-1109
- Towards individualized post-ECT care: piloting the symptom-titrated algorithm-based longitudinal ECT (STABLE) intervention.J ECT. 2008; 24: 179-182
- A rating scale for depression.J Neruol Neurosurg Psychiatry. 1960; 23: 56-62
- The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging Second.American Psychiatric Association, Washington, DC2001
- User's Guide for the Structured Clinical Interview for the DSM-IV Axis I Disorders-Research Version (SCID-I, Version 2.0).1996
- The Mini International Neuropsychiatric Interview (MINI): a short diagnostic structured interview: reliability and validity according to the CIDI.Eur Psychiatry. 1997; 12: 224-231
- Beck Scale for Suicide Ideation (BSS) Manual.Pearson, San Antonio, TX1991
- The Autobiographical Memory Interview Short Form: Manual for Administration and Scoring.Department of Psychiatry, New York State Psychiatric Institute, New York2001
- California Verbal Learning Test-Second Edition. Adult Version. Manual.Psychological Corporation, San Antonio, TX2000
- Delis Kaplan Executive Function System.The Psychological Corporation, San Antonio, TX2001
- DRS-2: Dementia Rating Scale-2 Professional Manual.Psychological Assessment Resources, Inc., Lutz, FL2001
- Stroop Color and Word Test: A manual for clincal and experimental use.Stoelting Co, Wood Dale, Il2002
- The Wechsler Test of Adult Reading (WTAR).The Psychological Corporation, San Antonio, TX2001
- Comparing actual to estimated base rates of “abnormal” scores on neuropsychological test batteries: implications for interpretation.Arch Clin Neuropsychol. 2010; 25: 14-21
- Practice effects and the use of alternate forms in serial neuropsychological testing.Arch Clin Neuropsychol. 2005; 20: 517-529
- Multifactorial determinants of the neurocognitive effecdts of electroconvulsive therapy.J ECT. 2014; 30: 165-176
- The cognitive effects of electroconvulsive therapy in community settings.Neuropsychopharmacology. 2007; 32: 244-254
- Long-term neurocognitive functioning after electroconvulsive therapy in patients with late-life depression.Acta Psychiatr Scand. 2018; 138: 223-231
Schmutte T,Wilkinson S: Suicide in older adults with and without known mental illness: results from the national violent death reporting system, 2003-2016. Am J Prev Med 2020; 58:584–590
- Relief of Expressed Suicidal Intent by ECT: A Consortium for Research in ECT Study.Am J Psychiatry. 2005; 162: 977-982
- Effects of continuation electroconvulsive therapy on quality of life in elderly depressed patients: a randomized clinical trial.J Psychiatr Res. 2018; 97: 65-69
- Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression: A Multisite Study From the Consortium for Research in Electroconvulsive Therapy (CORE).Arch Gen Psychiatry. 2006; 63: 1337-1344
- Cognitive effects of bifrontal versus right unilateral electrconvulsive therapy in the treatment of major depression in elderly adults: a randomized, controlled trial.J ECT. 2016; 32: 151-158
- Systematic review of cognitive effects of electroconvulsive therapy in late-life depression.Am J Geriatr Psychiatry. 2016; 24: 547-565
- Electroconvulsive therapy and risk of dementia in patients with affective disorders: a cohort Study.Lancet Psychiatry. 2018; 5: 348-356
Anderson I, McAllister-Williams R, Downey D, et al: Cognitive function after electroconvulsive therapy for depression: relationship to clinical response. Psychol Med 2020; 27:1–10
- Neurocognitive functioning after electroconvulsive therapy in late-life depression: a four-year prospective study.Acta Psychiatr Scand. 2020; 143: 141-150
Article info
Publication history
Published online: May 17, 2021
Accepted:
April 14,
2021
Received in revised form:
April 12,
2021
Received:
October 23,
2020
Footnotes
ClinicalTrials.gov identifier: NCT01028508.
Identification
Copyright
Published by Elsevier Inc. on behalf of American Association for Geriatric Psychiatry.
