Continuation/maintenance treatment with nortriptyline versus combined nortriptyline and ECT in late-life psychotic depression: a two-year randomized study.
OBJECTIVE
The identification of effective continuation and maintenance strategies for elderly patients with psychotic depression is a critical issue that has not been fully explored. The aim of this study was to assess the tolerability and efficacy of continuation/maintenance electroconvulsive therapy (ECT) in elderly patients with psychotic depression after acute ECT remission.


METHODS
The authors used a longitudinal, randomized, single-blind design to compare by survival analysis the 2-year outcome of two subgroups of elderly patients with psychotic unipolar depression who were ECT (plus nortriptyline) remitters. One group was treated with a continuation/maintenance nortriptyline regimen (N = 17) and the other with combined continuation/maintenance ECT plus nortriptyline (N = 16).


RESULTS
Over 2 years of treatment in elderly, psychotic, unipolar depressed ECT (plus nortriptyline) remitters, the mean survival time was significantly longer in the combined ECT plus nortriptyline subgroup than in the nortriptyline subgroup. No differences were observed between treatments with regard to tolerability.


CONCLUSIONS
This study supports the judicious use of combined continuation/maintenance ECT and antidepressant treatment in elderly patients with psychotic unipolar depression who are ECT remitters.
Clinical Institute of Psychiatry and Psychology, Hospital Clinic, University of Barcelona, Spain. vnavarro@clinic.ub.es
Victor
V
Navarro
Cristóbal
C
Gastó
Xavier
X
Torres
Guillem
G
Masana
Rafael
R
Penadés
Joana
J
Guarch
Mireia
M
Vázquez
Montserrat
M
Serra
Nuria
N
Pujol
Luis
L
Pintor
Rosa
R
Catalán
D000341:Affective Disorders, Psychotic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003266:Continuity of Patient Care; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009661:Nortriptyline / Q000009:adverse effects / Q000627:therapeutic use*; D010555:Personality Inventory; D055502:Secondary Prevention; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline