title: Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication.
abstract: BACKGROUND
  Severe depression can be a life-threatening disorder, especially in elderly patients. A fast-acting treatment is crucial for this group. Electroconvulsive therapy (ECT) may work faster than medication.
  
  
  OBJECTIVE
  To compare the speed of remission using ECT v. medication in elderly in-patients.
  
  
  METHODS
  The speed of remission in in-patients with a DSM-IV diagnosis of major depression (baseline MADRS score ≥20) was compared between 47 participants (mean age 74.0 years, s.d. = 7.4) from an ECT randomised controlled trial (RCT) and 81 participants (mean age 72.2 years, s.d. = 7.6) from a medication RCT (nortriptyline v. venlafaxine).
  
  
  RESULTS
  Mean time to remission was 3.1 weeks (s.d. = 1.1) for the ECT group and 4.0 weeks (s.d. = 1.0) for the medication group; the adjusted hazard ratio for remission within 5 weeks (ECT v. medication) was 3.4 (95% CI 1.9-6.2).
  
  
  CONCLUSIONS
  Considering the substantially higher speed of remission, ECT deserves a more prominent position in the treatment of elderly patients with severe depression.
authors.affiliation: Harm-Pieter Spaans, MD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Pascal Sienaert, MD, PhD, Filip Bouckaert, MD, University Psychiatric Centre - Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium; Julia F. van den Berg, PhD, Esmée Verwijk, MSc, King H. Kho, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Max L. Stek, MD, PhD, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands; Rob M. Kok, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Harm-Pieter
authors.initials: HP
authors.lastname: Spaans
authors.affiliation: Harm-Pieter Spaans, MD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Pascal Sienaert, MD, PhD, Filip Bouckaert, MD, University Psychiatric Centre - Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium; Julia F. van den Berg, PhD, Esmée Verwijk, MSc, King H. Kho, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Max L. Stek, MD, PhD, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands; Rob M. Kok, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Pascal
authors.initials: P
authors.lastname: Sienaert
authors.affiliation: Harm-Pieter Spaans, MD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Pascal Sienaert, MD, PhD, Filip Bouckaert, MD, University Psychiatric Centre - Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium; Julia F. van den Berg, PhD, Esmée Verwijk, MSc, King H. Kho, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Max L. Stek, MD, PhD, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands; Rob M. Kok, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Filip
authors.initials: F
authors.lastname: Bouckaert
authors.affiliation: Harm-Pieter Spaans, MD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Pascal Sienaert, MD, PhD, Filip Bouckaert, MD, University Psychiatric Centre - Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium; Julia F. van den Berg, PhD, Esmée Verwijk, MSc, King H. Kho, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Max L. Stek, MD, PhD, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands; Rob M. Kok, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Julia F
authors.initials: JF
authors.lastname: van den Berg
authors.affiliation: Harm-Pieter Spaans, MD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Pascal Sienaert, MD, PhD, Filip Bouckaert, MD, University Psychiatric Centre - Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium; Julia F. van den Berg, PhD, Esmée Verwijk, MSc, King H. Kho, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Max L. Stek, MD, PhD, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands; Rob M. Kok, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Esmée
authors.initials: E
authors.lastname: Verwijk
authors.affiliation: Harm-Pieter Spaans, MD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Pascal Sienaert, MD, PhD, Filip Bouckaert, MD, University Psychiatric Centre - Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium; Julia F. van den Berg, PhD, Esmée Verwijk, MSc, King H. Kho, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Max L. Stek, MD, PhD, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands; Rob M. Kok, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: King H
authors.initials: KH
authors.lastname: Kho
authors.affiliation: Harm-Pieter Spaans, MD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Pascal Sienaert, MD, PhD, Filip Bouckaert, MD, University Psychiatric Centre - Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium; Julia F. van den Berg, PhD, Esmée Verwijk, MSc, King H. Kho, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Max L. Stek, MD, PhD, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands; Rob M. Kok, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.affiliation: Harm-Pieter Spaans, MD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Pascal Sienaert, MD, PhD, Filip Bouckaert, MD, University Psychiatric Centre - Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium; Julia F. van den Berg, PhD, Esmée Verwijk, MSc, King H. Kho, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Max L. Stek, MD, PhD, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands; Rob M. Kok, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Rob M
authors.initials: RM
authors.lastname: Kok
mesh_terms: D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D003511:Cyclohexanols / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D009661:Nortriptyline / Q000627:therapeutic use*; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
chemical_list: D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D000069470:Venlafaxine Hydrochloride; D009661:Nortriptyline