Patterns of psychotropic medication use among patients with severe depression referred for electroconvulsive therapy: data from the Consortium for Research on Electroconvulsive Therapy.
Most studies of trends in antidepressant pharmacotherapy have focused on relatively mildly ill, nonpyschotic outpatients. In this report, we provide detailed information on psychotropic use among patients with unipolar depression participating in a large, multisite electroconculsive therapy (ECT) study. Adequacy of antidepressant medication trials was assessed with the Antidepressant Treatment History Form. Among patients with nonpsychotic depression, 27% (60/220) had not had an adequate trial of an antidepressant before ECT, and 63% (139/220) had had at least one inadequate trial. Surprisingly, 33% (79/243) of nonpsychotic patients had been prescribed an antipsychotic. Among patients with psychotic depression, 95% (101/106) had not been given an adequate combination of an antidepressant and antipsychotic agent, mostly due to low doses of the latter class. Among all patients in the trial, 61% (213/352) had been prescribed at least one benzodiazepine, and only 7% (24/352) had been given a lithium augmentation trial. Use of hypnotic agents and anticonvulsants was common. In conclusion, patients with severe depression referred for ECT with a unipolar depressive episode have high rates of psychotropic usage, much of which is inadequate.
Rasmussen
Keith G
KG
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA. rasmussen.keith@mayo.edu
Mueller
Martina
M
Kellner
Charles H
CH
Knapp
Rebecca G
RG
Petrides
George
G
Rummans
Teresa A
TA
Husain
Mustafa M
MM
O'connor
M Kevin
MK
Black
John L
JL
Sampson
Shirlene
S
Fink
Max
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D006801:Humans; D008875:Middle Aged
D000928:Antidepressive Agents