title: What was learned: studies by the consortium for research in ECT (CORE) 1997-2011.
abstract: OBJECTIVE
  To review the findings of the four-hospital collaborative studies of electroconvulsive therapy (ECT) in unipolar depressed patients known as CORE between 1997 and 2011. Unipolar depressed patients were treated with bilateral ECT, and on remission were randomly assigned to a fixed schedule continuation ECT or to combined lithium and nortriptyline for 6 months. A second study compared three electrode placements in unipolar and bipolar depressed patients.
  
  
  METHODS
  Nineteen published reports were reviewed. The findings are compared with those of a parallel multi-hospital study of ECT led by a Columbia University Collaboration (CUC) team that studied right unilateral ECT in a similar population with similar inclusion/exclusion and remission criteria. Successful ECT was followed by placebo, nortriptyline alone, or combined lithium, and nortriptyline.
  
  
  RESULTS
  Relapse rates after remission were similar with fixed schedule ECT as with medications. Predictors of outcome (psychosis, suicide risk, polarity, melancholia, atypical depression, age) and technical aspects (electrode placement, seizure threshold, speed of response) are discussed,
  
  
  CONCLUSIONS
  The findings offer criteria to optimize the selection of patients, the technique, and outcome of ECT for unipolar and bipolar depressed patients. Continuation ECT is an effective alternative to continuation treatment with lithium and nortriptyline. Bilateral electrode placement is more efficient than alternative placements. ECT relieves both bipolar and unipolar depression.
authors.affiliation: Departments of Psychiatry and Neurology, Stony Brook University, Long Island, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Fink
mesh_terms: D003866:Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods* / Q000592:standards; D006801:Humans
keywords: atypical depression; bipolar depression; continuation ECT; continuation medication; electroconvulsive therapy; electrode placement; melancholia; outcome predictors: age; psychosis; suicide; unipolar depression