Wednesday, June 2, 2021

ECT, Medication Combo Found as Safe as Medication Alone to Maintain Remission From MDD

Older adults being treated for depression with a combination of electroconvulsive therapy (ECT) and medication appear to have similar cognitive improvements over time as those treated with medication only, according to a report in the American Journal of Geriatric Psychiatry.

Sarah Lisanby, M.D., director of the Noninvasive Neuromodulation Unit at the National Institute of Mental Health, and colleagues looked at neurocognitive outcomes in adults aged 60 and over enrolled in the multicenter Prolonging Remission in Depressed Elderly (PRIDE) study. A 2016 analysis of that study, which appeared in the American Journal of Psychiatry, found that patients receiving a combination ECT and medication for six months experienced greater improvements in mood compared with those who received pharmacotherapy alone.

For the current study, Lisanby and colleagues examined six-month neurocognitive outcomes for a total of 120 patients with remitted depression who received either a combination of ECT (right unilateral ultrabrief pulse ECT), venlafaxine, and lithium or venlafaxine and lithium only as part of the PRIDE study. The researchers used standard instruments to assess attention and processing speed, verbal fluency, verbal learning and memory, memory of personal events in one’s own life, and executive functions.

With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to six-month follow-up for both groups of patients—those who received ECT, venlafaxine, and lithium as well as those who received medication alone. There were no significant differences between the two treatment groups at six 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.

“Our key finding is that neurocognitive function improved over the six-month follow-up period,” Lisanby and colleagues wrote. “Given that [the combination of ECT, venlafaxine, and lithium] was more effective in sustaining antidepressant remission than [medication alone] without increasing the risk of neurocognitive side effects, these results support the use of [the combination of ECT, venlafaxine, and lithium] to prolong remission from depression,” Lisanby and colleagues wrote.

Lisanby and colleagues acknowledged that some of the patients in the study could have cognitive difficulties following the six-month time point. “Future research is warranted to examine the longer term cognitive, and antidepressant, trajectory,” they wrote.

For related news, see the Psychiatric News article “Older Patients With Depression May Benefit From ECT, Medication Combo.”