A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study.

Published

Journal Article

OBJECTIVE: The randomized phase (phase 2) of the Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy and tolerability of continuation ECT plus medication compared with medication alone in depressed geriatric patients after a successful course of ECT (phase 1). METHOD: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, augmented with venlafaxine. Phase 2 compared two randomized treatment arms: a medication only arm (venlafaxine plus lithium, over 24 weeks) and an ECT plus medication arm (four continuation ECT treatments over 1 month, plus additional ECT as needed, using the Symptom-Titrated, Algorithm-Based Longitudinal ECT [STABLE] algorithm, while continuing venlafaxine plus lithium). The intent-to-treat sample comprised 120 remitters from phase 1. The primary efficacy outcome measure was score on the 24-item Hamilton Depression Rating Scale (HAM-D), and the secondary efficacy outcome was score on the Clinical Global Impressions severity scale (CGI-S). Tolerability as measured by neurocognitive performance (reported elsewhere) was assessed using an extensive test battery; global cognitive functioning as assessed by the Mini-Mental State Examination (MMSE) is reported here. Longitudinal mixed-effects repeated-measures modeling was used to compare ECT plus medication and medication alone for efficacy and global cognitive function outcomes. RESULTS: At 24 weeks, the ECT plus medication group had statistically significantly lower HAM-D scores than the medication only group. The difference in adjusted mean HAM-D scores at study end was 4.2 (95% CI=1.6, 6.9). Significantly more patients in the ECT plus medication group were rated "not ill at all" on the CGI-S compared with the medication only group. There was no statistically significant difference between groups in MMSE score. CONCLUSIONS: Additional ECT after remission (here operationalized as four continuation ECT treatments followed by further ECT only as needed) was beneficial in sustaining mood improvement for most patients.

Full Text

Duke Authors

Cited Authors

  • Kellner, CH; Husain, MM; Knapp, RG; McCall, WV; Petrides, G; Rudorfer, MV; Young, RC; Sampson, S; McClintock, SM; Mueller, M; Prudic, J; Greenberg, RM; Weiner, RD; Bailine, SH; Rosenquist, PB; Raza, A; Kaliora, S; Latoussakis, V; Tobias, KG; Briggs, MC; Liebman, LS; Geduldig, ET; Teklehaimanot, AA; Dooley, M; Lisanby, SH; CORE/PRIDE Work Group,

Published Date

  • November 1, 2016

Published In

Volume / Issue

  • 173 / 11

Start / End Page

  • 1110 - 1118

PubMed ID

  • 27418381

Pubmed Central ID

  • 27418381

Electronic International Standard Serial Number (EISSN)

  • 1535-7228

Digital Object Identifier (DOI)

  • 10.1176/appi.ajp.2016.16010118

Language

  • eng

Conference Location

  • United States