title: Electroconvulsive therapy in the treatment-resistant patient.
abstract: In medication-resistant patients with major depressive disorder, the response rate with bilateral electroconvulsive therapy (ECT) drops to 50% from the expected range of 80% to 90%. Relapse rates following ECT are high in medication-resistant depressed patients and are clustered in the first 4 months following clinical response. Medication resistance during the index episode predicts a high rate of relapse, whereas those patients who have not received an adequate medication trial prior to ECT are less likely to relapse. If a patient who fails an antidepressant trial then responds to a course of ECT, alternative pharmacologic strategies or maintenance ECT should be considered to decrease the likelihood of relapse. Patients who do not respond to a traditional course of bilateral ECT may respond subsequently to longer courses of bilateral ECT at markedly suprathreshold stimulus intensity, or may respond to a different class of antidepressant medication from that which they failed previously.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: D P
authors.initials: DP
authors.lastname: Devanand
authors.forename: H A
authors.initials: HA
authors.lastname: Sackeim
authors.forename: J
authors.initials: J
authors.lastname: Prudic
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000628:therapy*; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D007839:Functional Laterality; D006801:Humans; D012008:Recurrence
chemical_list: D000928:Antidepressive Agents