Prevention of Relapse With Maintenance Electroconvulsive Therapy in Elderly Patients With Major Depressive Episode

Rapinesi, Chiara; Kotzalidis, Georgios D.; Serata, Daniele; Casale, Antonio Del; Scatena, Paola; Mazzarini, Lorenzo; Caccia, Federica; Brugnoli, Roberto; Carbonetti, Paolo; Fensore, Claudio; Girardi, Paolo

doi:10.1097/yct.0b013e31826d369a

Cited by 11 publications

(5 citation statements)

References 15 publications

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“…Specifically, individuals in both the psychotic disorder group, encompassing schizophrenia and schizoaffective disorder, as well as the mood disorders group, comprising major depressive disorder and bipolar disorder, exhibited a statistically significant reduction in the aforementioned parameters. These results are consistent with previous studies that have demonstrated the effectiveness of continuation-maintenance ECT in reducing the risk of relapse and readmission rates for patients with schizophrenia, 20,21 bipolar disorder, 22,23 and major depressive disorder, 10,24 and schizoaffective disorder. 23,25 The reduction in admission days and hospitalizations in patients undergoing continuation-maintenance ECT can be attributed to several factors.…”

Section: Discussionsupporting

confidence: 92%

Effect of Continuation-Maintenance Electroconvulsive Therapy on Hospitalization: A Retrospective Mirror-Image Study

Sombatcharoen-non,

Yamnim,

Jullagate

et al. 2023

NDT

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Objective To examine the effect of continuation-maintenance electroconvulsive therapy (ECT) on psychiatric hospitalization in Thai patients. Methods This retrospective mirror-image study reviewed medical records of Thai patients who received continuation-maintenance ECT at Ramathibodi Hospital, Bangkok, between September 2013 and December 2022. The initiation of continuation-maintenance ECT served as the index event, establishing pre-initiation and post-initiation periods. The primary outcome measured the differences in admissions and admission days before and after continuation-maintenance ECT. Results Forty-seven patients were included in the study, with diagnoses of schizophrenia (38.3%), schizoaffective disorder (21.3%), and bipolar disorder (19.1%) being the most common. The mean (standard deviation; SD) age was 44.6 (12.2) years. The total duration that patients received continuation-maintenance ECT was 53 ± 38.2 months. Following the initiation of ECT, there was a significant reduction in the median (interquartile range) number of hospitalizations for all patients (2 [2] versus 1 [2], p < 0.001), as well as for the psychotic disorder group (2 [2] versus 1 [2.75], p = 0.006) and the mood disorder group (2 [2] versus 1 [2], p = 0.02). Moreover, there was a significant reduction in the median (interquartile range) length of admission days for all patients after the initiation of continuation-maintenance ECT (66 [69] versus 20 [53], p < 0.001). Specifically, the psychotic disorder group (64.5 [74] versus 15.5 [62], p = 0.02) and mood disorder group (74 [57] versus 20 [54], p = 0.008) demonstrated statistically significant decreases in admission days. Conclusion Continuation-maintenance ECT may be an effective treatment option for reducing hospitalizations and admission days in patients with various psychiatric diagnoses. However, the study also highlights the need to carefully consider the potential adverse effects of ECT in clinical decision-making.

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Section: Discussionsupporting

confidence: 92%

Effect of Continuation-Maintenance Electroconvulsive Therapy on Hospitalization: A Retrospective Mirror-Image Study

Sombatcharoen-non,

Yamnim,

Jullagate

et al. 2023

NDT

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“…Other cognitive outcomes are reported in the table of included studies (Supplementary Data File, Supplemental Digital Content, http://links.lww.com/JECT/A186), although there was significant variation in cognitive domains examined and the data were not suitable for combining with meta-analysis or albatross plots. A further 2 prospective studies also measured MMSE; Rapinesi et al 39 found no differences between the groups, although it did not report any data, which could be included in the albatross plot, while Swoboda et al 36 did not report a comparison with the control group.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies reported outcomes of relapse rate, consisting of 380 patients receiving C/M-ECT and 476 controls. Of the studies, 6 were RCTs, 22,24,28,[33][34][35] 6 were prospective studies, 14,[36][37][38][39][40] and 2 were retrospective studies. 27,29 The definition of relapse varied considerably across studies, such as being defined by specific cut off scores or changes in scores on depression rating scales, meeting full diagnostic criteria, suicidality, rehospitalization, or need to recommence acute ECT (Supplementary Data File, Supplemental Digital Content, http://links.lww.…”

Section: Relapse Ratementioning

confidence: 99%

“…This included studies reporting symptom severity in terms of Hamilton Depression Rating Scale (5 studies) 23,24,30,35,39 and Clinical Global Impression scale (3 studies). 14,35,39 Inspection of the plot indicates a negative effect between patients receiving C/M-ECT and depressive symptoms (ie, patients receiving C/M-ECT tended to have less severe depressive symptoms) although with a small number of studies and significant heterogeneity, effect size is difficult to estimate. A, Albatross plot for relapse rates in patients receiving C/M-ECT compared with pharmacotherapy controls, with contours for relative risk of relapse (RR), grouped according to study type.…”

Section: Illness Severity Outcomesmentioning

confidence: 99%

“…Six studies reported data on severity of depressive symptoms after C/M-ECT of which 8 data points are shown on the albatross plot in Figure 3. This included studies reporting symptom severity in terms of Hamilton Depression Rating Scale (5 studies) 23,24,30,35,39 and Clinical Global Impression scale (3 studies). 14,35,39 Inspection of the plot indicates a negative effect between patients receiving C/M-ECT and depressive symptoms (ie, patients receiving C/M-ECT tended to have less severe depressive symptoms) although with a small number of studies and significant heterogeneity, effect size is difficult to estimate.…”

Section: Illness Severity Outcomesmentioning

confidence: 99%

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The Efficacy and Tolerability of Continuation and Maintenance Electroconvulsive Therapy for Depression

Rowland

Mann

Azeem

2023

J ECT

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Electroconvulsive therapy (ECT) is a highly effective treatment for severe and treatment-resistant depression, but relapse rates remain high despite maintenance pharmacotherapy. Continuation or maintenance ECT (C/M-ECT) offers the potential to prevent relapses in the most unwell patients, but there remains disagreement among guidelines regarding its efficacy and tolerability. This review aims to summarize and assess the current evidence for the efficacy and tolerability of continuation and maintenance ECT for depression, including data from randomized and observational studies, which included an appropriate control group. Twenty studies were found meeting inclusion criteria. There was evidence from 14 studies suggesting that relapse rates are reduced in those receiving C/M-ECT. There was evidence from 6 studies suggesting that C/M-ECT had no effect on global cognitive function. Detailed neuropsychological testing was limited, but within studies that assessed specific cognitive domains, there was not consistent evidence for deficits in C/M-ECT compared with the control group. The certainty of evidence across outcomes was low or very low because of inclusion of observational studies, heterogeneity of study design, and patient populations. The findings add further weight to evidence suggesting that C/M-ECT is a viable treatment option to prevent relapse in severe depression and provides clinicians with further evidence for the benefits and risks of C/M-ECT when discussing treatment options with patients. Future research should focus on randomized or well-designed prospective studies with sufficient follow-up to determine longer-term outcomes, while including a standardized, detailed neurocognitive battery to assess potential adverse effects.

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A Review of Therapeutics for Treatment-Resistant Depression in the Older Adult

Blaszczyk,

Mathys,

2023

Drugs Aging

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Prevention of Relapse With Maintenance Electroconvulsive Therapy in Elderly Patients With Major Depressive Episode

Cited by 11 publications

References 15 publications

Effect of Continuation-Maintenance Electroconvulsive Therapy on Hospitalization: A Retrospective Mirror-Image Study

Effect of Continuation-Maintenance Electroconvulsive Therapy on Hospitalization: A Retrospective Mirror-Image Study

The Efficacy and Tolerability of Continuation and Maintenance Electroconvulsive Therapy for Depression

A Review of Therapeutics for Treatment-Resistant Depression in the Older Adult

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