Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE).
BACKGROUND
Although electroconvulsive therapy (ECT) has been shown to be extremely effective for the acute treatment of major depression, it has never been systematically assessed as a strategy for relapse prevention.


OBJECTIVE
To evaluate the comparative efficacy of continuation ECT (C-ECT) and the combination of lithium carbonate plus nortriptyline hydrochloride (C-Pharm) in the prevention of depressive relapse.


METHODS
Multisite, randomized, parallel design, 6-month trial performed from 1997 to 2004.


METHODS
Five academic medical centers and their outpatient psychiatry clinics.


METHODS
Two hundred one patients with Structured Clinical Interview for DSM-IV-diagnosed unipolar depression who had remitted with a course of bilateral ECT.


METHODS
Random assignment to 2 treatment groups receiving either C-ECT (10 treatments) or C-Pharm for 6 months.


METHODS
Relapse of depression, compared between the C-ECT and C-Pharm groups.


RESULTS
In the C-ECT group, 37.1% experienced disease relapse, 46.1% continued to have disease remission at the study end, and 16.8% dropped out of the study. In the C-Pharm group, 31.6% experienced disease relapse, 46.3% continued to have disease remission, and 22.1% dropped out of the study. Both Kaplan-Meier and Cox proportional hazards regression analyses indicated no statistically significant differences in overall survival curves and time to relapse for the groups. Mean +/- SD time to relapse for the C-ECT group was 9.1 +/- 7.0 weeks compared with 6.7 +/- 4.6 weeks for the C-Pharm group (P = .13). Both groups had relapse proportions significantly lower than a historical placebo control from a similarly designed study.


CONCLUSIONS
Both C-ECT and C-Pharm were shown to be superior to a historical placebo control, but both had limited efficacy, with more than half of patients either experiencing disease relapse or dropping out of the study. Even more effective strategies for relapse prevention in mood disorders are urgently needed.
Kellner
Charles H
CH
Department of Psychiatry, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 183 South Orange Avenue, Newark, NJ 07103, USA. kellner@umdnj.edu
Knapp
Rebecca G
RG
Petrides
Georgios
G
Rummans
Teresa A
TA
Husain
Mustafa M
MM
Rasmussen
Keith
K
Mueller
Martina
M
Bernstein
Hilary J
HJ
O'Connor
Kevin
K
Smith
Glenn
G
Biggs
Melanie
M
Bailine
Samuel H
SH
Malur
Chitra
C
Yim
Eunsil
E
McClintock
Shawn
S
Sampson
Shirlene
S
Fink
Max
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use; D010352:Patient Dropouts; D016016:Proportional Hazards Models; D012107:Research Design; D055502:Secondary Prevention; D016896:Treatment Outcome
D000928:Antidepressive Agents; D016651:Lithium Carbonate; D009661:Nortriptyline