Imipramine with electrical treatment in depression—A controlled trial

Abstract

Since the introduction of anti-depressant drugs into general use in the psychiatric field, there have been several statements to the effect that such a drug administered concurrently with electrical treatment reduces the number of shocks required to achieve a satisfactory response. This has been claimed by Sargant (1961) but without experimental support. Dunlop (1960) has published a comparison between the number of electrical treatments given with the anti-depressant drug during a particular attack, and the number of treatments without the aid of a drug in an earlier attack in the same patient: however, comparison of treatments in the same group of patients at different times is unreliable because there may be other factors to account for the differences noted. A controlled trial is necessary to ensure that all factors are constant other than the one under consideration.

Effective Use of Electroconvulsive Therapy in Late-Life Depression

“…Although these authors did not specifically examine relapse rates, they found no difference between the groups in mean Hamilton Depression Rating Scale (HDRS) scores 6 weeks post-ECT. Further, consistent with previous studies (54)(55)(56), starting antidepressant medication during ECT conveyed no benefit in terms of speed or eventual rate of response (58). Thus, the benefit of simultaneously treating patients with antidepressant medication and ECT to prevent relapse has yet to be proven.…”

“…Studies undertaken in the 1960s, in which patients took antidepressant medication in conjunction with ECT, found that continuation of the antidepressant after ECT was associated with a 6-month relapse rate of approximately 20%, compared with 50% to 70% in the control groups (54)(55)(56). However, at that time ECT was frequently used as a first-line treatment, and it is possible that some patients in these studies would have responded to the antidepressant medication and remained well on it, even if they had not received ECT.…”

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

“…As modern studies of more treatmentresistant patients and clearer reporting of methodology began to be conducted, relapse rates rose towards presentday levels. It should be noted that following the publication of three important early trials (Imlah et al, 1965;Kay et al, 1970;Seager and Bird, 1962), with the exception of one small trial in 1984 (Krog-Meyer et al, 1984), no other prospective long-term follow-up studies of continuation pharmacotherapy meeting inclusion criteria were found between 1970 and the early 1990s, perhaps coinciding with diminishing use of ECT. Given this gap in evidence, it is unclear when precisely the shift in relapse rates might have occurred.…”

“…Three RCTs (Lauritzen et al, 1996;Sackeim et al, 2001;Yildiz et al, 2010) provided extractable data at 3 months and seven (Imlah et al, 1965;Kay et al, 1970;Krog-Meyer et al, 1984;Lauritzen et al, 1996;Sackeim et al, 2001;Seager and Bird, 1962;van den Broek et al, 2006) at 6 months. Relapse rates were 62.7% (95% CI ¼ 47.6-75.8%, I 2 ¼ 0) at 3 months and 65.5% (95% CI ¼ 49.7-78.5%, I 2 ¼ 72%) at 6 months.…”

“…Early research from the United Kingdom demonstrated the efficacy of antidepressants over placebo with 6-month relapse rates in tricyclic antidepressant (TCA)-or monoamine oxidase inhibitor (MAOI)-treated patients of about 20% compared with 40-70% in untreated or benzodiazepine-only-treated patients (Imlah et al, 1965;Kay et al, 1970;Seager and Bird, 1962). However, more recent studies are less favorable, with relapse rates typically about 40-50% at 6 months despite vigorous continuation therapy, such as antidepressant-lithium combination or continuation ECT (C-ECT; Kellner et al, 2006;Prudic et al, 2013;Sackeim et al, 2001).…”