title: The influence of concomitant antidepressant medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy.
abstract: BACKGROUND
  A major problem in the treatment of severe depression is the onset latency until clinical improvement. So far, electroconvulsive therapy (ECT) is the most effective somatic treatment of depression. This holds especially true for treatment-refractory disturbances. However, not all patients respond to conventional unilateral ECT. In certain cases, subsequent clinical response can be achieved using bilateral or high-dose unilateral ECT. Also, a concomitant pharmacotherapy can be utilized to augment therapeutic effectiveness. Surprisingly, data in this field are widely lacking and only few studies showed advantages of an ECT/tricyclic antidepressant combination.
  
  
  METHODS
  We retrospectively evaluated 5482 treatments in 455 patients to investigate possible therapeutic advantages in combination therapies versus ECT monotherapy. Main outcome criteria were clinical effectiveness and tolerability. Moreover, treatment modalities and ictal neurophysiological parameters that might influence treatment outcome were analysed.
  
  
  RESULTS
  A total of 18.2% of our treatments were ECT monotherapy, 8.87% were done with one antidepressant. Seizure duration was unaffected by the most antidepressants. SSRI caused a lengthened seizure activity. Postictal suppression was lower in mirtazapine and higher in SSRI and SNRI treated patients. A significant enhancement of therapeutic effectiveness could be seen in the patient group receiving tricyclics, SSRI or mirtazapine. Serious adverse events were not recorded.
  
  
  CONCLUSIONS
  Our study supports the hypothesis that mirtazapine can be used to enhance the therapeutic effectiveness of ECT. Controlled studies are necessary to further investigate the possible advantages of ECT and pharmacotherapy combinations, especially the use of modern dually acting antidepressants which have proven their good effectiveness in treatment-resistant depression.
authors: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany. baghai@med.uni-muenchen.de
authors: Thomas C
authors: TC
authors: Baghai
authors: Alain
authors: A
authors: Marcuse
authors: Melanie
authors: M
authors: Brosch
authors: Cornelius
authors: C
authors: Schüle
authors: Daniela
authors: D
authors: Eser
authors: Caroline
authors: C
authors: Nothdurfter
authors: Yvonne
authors: Y
authors: Steng
authors: Ines
authors: I
authors: Noack
authors: Katrin
authors: K
authors: Pietschmann
authors: Hans-Jürgen
authors: HJ
authors: Möller
authors: Rainer
authors: R
authors: Rupprecht