Sarah H Lisanby1, Shawn M McClintock2, William V McCall3, Rebecca G Knapp4, C Munro Cullum5, Martina Mueller4, Zhi-De Deng6, Abeba A Teklehaimanot4, Matthew V Rudorfer7, Elisabeth Bernhardt5, George Alexopoulos8, Samuel H Bailine9, Mimi C Briggs10, Emma T Geduldig10, Robert M Greenberg11, Mustafa M Husain2, Styliani Kaliora9, Vassilios Latoussakis8, Lauren S Liebman10, Georgios Petrides9, Joan Prudic12, Peter B Rosenquist3, Shirlene Sampson13, Kristen G Tobias14, Richard D Weiner2, Robert C Young8, Charles H Kellner10. 1. Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program (SHL, ZDD), National Institute of Mental Health, National Institutes of Health, Bethesda, MD; Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences (SHL, EB, RDW), Duke University School of Medicine, Durham, NC. Electronic address: Sarah.Lisanby@NIH.gov. 2. Division of Psychology, Department of Psychiatry (SMM, CMC, MMH), UT Southwestern Medical Center, Dallas, TX. 3. Department of Psychiatry and Health Behavior (WVM, PBR), Medical College of Georgia, Augusta University, Augusta, GA. 4. Medical University of South Carolina (RGK, MM, AAT), Charleston, SC. 5. Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences (SHL, EB, RDW), Duke University School of Medicine, Durham, NC. 6. Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program (SHL, ZDD), National Institute of Mental Health, National Institutes of Health, Bethesda, MD. 7. Division of Services and Intervention Research (MVR), National Institute of Mental Health, National Institutes of Health, Bethesda, MD. 8. Department of Psychiatry and Behavioral Sciences (GA, VL, RCY), New York Presbyterian/Weill Cornell Medical Center, White Plains, NY. 9. Department of Psychiatry (SHB, SB, GP), Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY. 10. Department of Psychiatry (MCB, ETG, LSL, CHK), Icahn School of Medicine at Mount Sinai, New York, NY. 11. NYU Langone (RMG), New York, NY. 12. Department of Psychiatry (JP), Columbia University/New York State Psychiatric Institute, New York, NY. 13. Department of Psychiatry and Psychology (SS), Mayo Clinic, Rochester, MN. 14. VA New Jersey Health Care System (KGT), East Orange, NJ.
Abstract
OBJECTIVE: There is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study. METHOD: After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test). RESULTS: With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 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. CONCLUSION: To our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression. Published by Elsevier Inc.
OBJECTIVE: There is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study. METHOD: After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test). RESULTS: With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 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. CONCLUSION: To our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression. Published by Elsevier Inc.
Entities:
Keywords:
Electroconvulsive therapy; major depression; neurocognitive adverse effects
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