Sarah H Lisanby1, Shawn M McClintock2, George Alexopoulos3, Samuel H Bailine4, Elisabeth Bernhardt5, Mimi C Briggs6, C Munro Cullum7, Zhi-De Deng8, Mary Dooley9, Emma T Geduldig6, Robert M Greenberg10, Mustafa M Husain11, Styliani Kaliora4, Rebecca G Knapp9, Vassilios Latoussakis3, Lauren S Liebman6, William V McCall12, Martina Mueller9, Georgios Petrides4, Joan Prudic13, Peter B Rosenquist12, Matthew V Rudorfer14, Shirlene Sampson15, Abeba A Teklehaimanot9, Kristen G Tobias16, Richard D Weiner17, Robert C Young3, Charles H Kellner6. 1. Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine (SHL - Now at the National Institute of Mental Health; SMM, MMH), Durham, NC; Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health (SHL, Z-DD), Bethesda, Maryland. 2. Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine (SHL - Now at the National Institute of Mental Health; SMM, MMH), Durham, NC; Department of Psychiatry, UT Southwestern Medical Center (SMM, CMC, MMH), Dallas, TX. Electronic address: shawn.mcclintock@utsouthwestern.edu. 3. Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center (GA, VL, RCY), White Plains, NY. 4. Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System (SHB, SK, GP), New York, NY. 5. Department of Nursing, Duke University School of Medicine (EB), Durham, NC. 6. Department of Psychiatry, Icahn School of Medicine at Mount Sinai (MCB, ETG, LSL, CHK), New York, NY. 7. Department of Psychiatry, UT Southwestern Medical Center (SMM, CMC, MMH), Dallas, TX. 8. Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health (SHL, Z-DD), Bethesda, Maryland. 9. Department of Public Health Sciences, College of Medicine, Medical University of South Carolina (MD, RGK, MM, AAT), Charleston, SC. 10. NYU Langone (RMG), New York, NY. 11. Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine (SHL - Now at the National Institute of Mental Health; SMM, MMH), Durham, NC; Department of Psychiatry, UT Southwestern Medical Center (SMM, CMC, MMH), Dallas, TX. 12. Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University (WVM, PBR), Augusta, GA. 13. Department of Psychiatry, Columbia University/New York State Psychiatric Institute (JP), New York, NY. 14. Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health (MVR), Bethesda, MD. 15. Department of Psychiatry and Psychology, Mayo Clinic (SS), Rochester, MN. 16. VA New Jersey Health Care System (KGT), East Orange, NJ. 17. Department of Psychiatry and Behavioral Sciences, Duke University (RDW), Durham, NC.
Abstract
OBJECTIVE: There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study. METHODS: Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05. RESULTS: A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest. CONCLUSION: This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.
OBJECTIVE: There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study. METHODS: Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05. RESULTS: A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest. CONCLUSION: This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.
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