Relapse During Continuation Pharmacotherapy after Acute Response to ECT: A Comparison of Usual Care versus Protocolized Treatment

Tew, James D.; Mulsant, Benoit H.; Haskett, Roger F.; Prudic, Joan; Begley, Amy; Sackeïm, Harold A.

doi:10.1080/10401230601163360

Cited by 42 publications

(24 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that only 34% of all patients sustained remission, which is a striking result. This high relapse rate is one of the highest rates in literature, which vary between 44.7 and 64.3% in patients with mood disorders (17,18,21,23,28). Prudic et al (22) found disappointingly low remission rates with ECT in a community setting that are noteworthy to understand the real world, similar to our findings, but the follow-up duration was 6 months in their study.…”

Section: Discussionsupporting

confidence: 77%

“…Early studies reported that 50% of patients who responded to ECT relapsed within the first 3 months without any continuation therapy (15,16). To date, only a few controlled continuation studies have been published with short follow-up durations, such as six months (17,18). The few studies in the literature with longer durations but having a small number of patients, an uncertain definition of remission, or with a retrospective design were not informative (19,20).…”

Section: Introductonmentioning

confidence: 99%

See 1 more Smart Citation

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Çakιr¹,

Çağlar²

2017

Arch Neuropsychiatr

View full text Add to dashboard Cite

Introduction: Electroconvulsive therapy (ECT) is known to be an effective option in the treatment of mood disorders, especially resistant depression. However, the remission achieved by ECT was reported to be not long lasting enough. The aim of the present study was to investigate the relapse/recurrence rates and associated risk factors during the first year after ECT in patients diagnosed with mood disorders.Methods: In a naturalistic observation, patients diagnosed with unipolar depressive disorder or a depressive episode of bipolar disorder and who had achieved remission by ECT were followed up for at least one year. The patients were evaluated with structured interviews during the follow-up period. The relapse/recurrence rates were the primary outcome measurements, while hospitalization and suicide attempts were the secondary outcome measurements. The remitted and non-remitted patients were compared regarding the clinical features, ECT, and pharmacological variables.Results: Fifty of 62 patients who had achieved remission with ECT completed the one year follow-up period. Thirty-three patients (66%) had relapse/recurrence, while 17 (34%) patients remained in remission. The relapse rates were similar in patients with unipolar depression and bipolar disorders. The mean number of ECT sessions was higher in relapsed patients with bipolar disorders. Multiple episodes were more frequent in non-remitted patients with unipolar depression. Comorbid psychiatric diagnosis was higher in non-remitted patients with unipolar and bipolar disorders. Conclusion:The relapse/recurrence rate was found to be fairly high in the first year of follow-up in patients who had achieved remission with ECT. ECT decisions should be made carefully in patients with comorbid psychiatric diagnosis and multiple episodes as these are more risky. The ECT application procedure and successive maintenance treatment (maintenance ECT, pharmacotherapy, and psychotherapy) should be planned to sustain the remission for patients with mood disorders in long-term follow-up.Keywords: Electroconvulsive therapy, mood disorders, relapse, remission, major depression Arch Neuropsychiatry 2017; 54: 196-201 • DOI: 10.5152/npa.2016.14845 Electroconvulsive ABSTRACT INTRODUCTONThe efficacy of pharmacotherapy in mood disorders is not satisfactory, and the desired remission rates are not currently achieved in either unipolar (UD) or bipolar disorders (BP) (1,2,3). Electroconvulsive therapy (ECT) has been used for a long time with successful response and remission rates; 80-90% of patients experience an improvement, and the efficacy of ECT has been established to be between 60% and 90% regarding acute response in treatment-resistant depression (3,4,5,6,7). ECT is also considered to be an effective treatment in bipolar depression and is indicated to be equally effective in unipolar and bipolar depression (8,9,10). The effectiveness of ECT in the treatment of UD and BP has also been reported, and it is recommended by guidelines (11,12,13,14). However, the literature data...

show abstract

Section: Discussionsupporting

confidence: 77%

Section: Introductonmentioning

confidence: 99%

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Çakιr¹,

Çağlar²

2017

Arch Neuropsychiatr

View full text Add to dashboard Cite

show abstract

“…Nevertheless, previous reports, including the CORE study, indicate occurrence of post-ECT relapses within 2 to 4 months. 7,12,17 Unstratified randomization for presence of psychosis, melancholic features, medication resistance, and especially previous ECT courses in this study is a shortcoming that needs to be considered in future trials. It is difficult to draw a conclusion about whether the coadministration of sertraline or fortuitous inclusion of more patients who had previous ECT decreased the efficacy of ECT in the c-pharm early group.…”

Section: Limitationsmentioning

confidence: 88%

“…31 This is comparable to the recently reported 10% rate of ECT administration in US hospitals for recurrent depression. 12 Severity of depression in this study population was indicated by the 70.5% rate of medication resistance, the 65.2% rate of baseline suicidal thoughts and acts, and the mean baseline depression score of 64% of the maximum MADRS score.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 In naturalistic follow-up studies, it has been reported that 51% of MDD patients receiving usual care with continuation antidepressants alone or in combination with lithium experienced relapse within 6 months. 12,13 A prospective naturalistic study found a 64.3% post-ECT relapse rate at 6 months, with a median time to relapse of 8.6 weeks. 14 The Health Technology Assessment Committee reported relapse rates of 33% for c-ECT, 32% with lithium plus a tricyclic antidepressant, 56% with an tricyclic antidepressant, and 72% without treatment at 12 months.…”

mentioning

confidence: 98%

See 1 more Smart Citation

Combination of Pharmacotherapy With Electroconvulsive Therapy in Prevention of Depressive Relapse

Yıldız

Mantar²,

Şimşek³

et al. 2010

The Journal of ECT

View full text Add to dashboard Cite

show abstract

Electroconvulsive therapy for preventing relapse and recurrence in people with depression

Munkholm

Jørgensen

Paludan-Müller

2022

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

Relapse During Continuation Pharmacotherapy after Acute Response to ECT: A Comparison of Usual Care versus Protocolized Treatment

Abstract: The relapse rate associated with usual care following ECT was comparable to that of protocolized pharmacotherapy. This suggests that high relapse rates following ECT are not due solely to an "efficacy-effectiveness gap."

Cited by 42 publications

References 11 publications

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up

Combination of Pharmacotherapy With Electroconvulsive Therapy in Prevention of Depressive Relapse

Electroconvulsive therapy for preventing relapse and recurrence in people with depression

Contact Info

Product

Resources

About