Skip to main content

Effects of a Course of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy Combined With Venlafaxine on Insomnia Symptoms in Elderly Depressed Patients.

Publication ,  Conference
McCall, WV; Lisanby, SH; Rosenquist, PB; Dooley, M; Husain, MM; Knapp, RG; Petrides, G; Rudorfer, MV; Young, RC; McClintock, SM; Mueller, M ...
Published in: J Clin Psychiatry
2018

OBJECTIVE: Antidepressant medications have a variety of effects on sleep, apart from their antidepressant effects. It is unknown whether electroconvulsive therapy (ECT) has effects on perceived sleep in depressed patients. This secondary analysis examines the effects of ECT on perceived sleep, separate from its antidepressant effects. METHODS: Elderly patients with major depressive disorder, as defined by DSM-IV, received open-label high-dose, right unilateral ultrabrief pulse ECT, combined with venlafaxine, as part of participating in phase 1 of the National Institute of Mental Health-supported study Prolonging Remission in Depressed Elderly (PRIDE). Phase 1 of PRIDE participant enrollment period extended from February 2009 to August 2014. Depression severity was measured with the Hamilton Depression Rating Scale-24 item (HDRS₂₄), and measures of insomnia severity were extracted from the HDRS₂₄. Participants were characterized at baseline as either "high-insomnia" or "low-insomnia" subtypes, based upon the sum of the 3 HDRS₂₄ sleep items as either 4-6 or 0-3, respectively. Insomnia scores were followed during ECT and were adjusted for the sum of all the HDRS₂₄ non-sleep items. Generalized linear models were used for longitudinal analysis of insomnia scores. RESULTS: Two hundred forty patients participated, with 48.3% in the high-insomnia and 51.7% in the low-insomnia group. Although there was a reduction in the insomnia scores in the high-insomnia group, only 12.4% of them experienced remission of insomnia after a course of ECT, despite an increase in utilization of sleep aids across the course of ECT, from 8.6% to 23.2%. The degree of improvement in insomnia symptoms paralleled the degree of improvement in non-insomnia symptoms. A "low" amount of improvement on the sum of the HDRS non-insomnia items (HDRS-sleep) was accompanied by a "low" amount of improvement in insomnia scores (change of -1.6 ± 1.2, P < .0001), while a "high" amount of improvement on the sum of the HDRS non-insomnia items was accompanied by a "higher" amount of improvement in insomnia scores (change of -3.1 ± 1.6, P < .0001). After adjustment for non-insomnia symptoms, there was no change in insomnia in the low-insomnia group. CONCLUSIONS: We found that ECT, combined with venlafaxine, has a modest anti-insomnia effect that is linked to its antidepressant effect. Most patients will have some degree of residual insomnia after ECT, and will require some consideration of whether additional, targeted assessment and treatment of insomnia is warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01028508.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Clin Psychiatry

DOI

EISSN

1555-2101

Publication Date

2018

Volume

79

Issue

2

Location

United States

Related Subject Headings

  • Venlafaxine Hydrochloride
  • Treatment Outcome
  • Sleep Initiation and Maintenance Disorders
  • Severity of Illness Index
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Male
  • Humans
  • Female
  • Electroconvulsive Therapy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
McCall, W. V., Lisanby, S. H., Rosenquist, P. B., Dooley, M., Husain, M. M., Knapp, R. G., … CORE/PRIDE Work Group. (2018). Effects of a Course of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy Combined With Venlafaxine on Insomnia Symptoms in Elderly Depressed Patients. In J Clin Psychiatry (Vol. 79). United States. https://doi.org/10.4088/JCP.16m11089
McCall, W Vaughn, Sarah H. Lisanby, Peter B. Rosenquist, Mary Dooley, Mustafa M. Husain, Rebecca G. Knapp, Georgios Petrides, et al. “Effects of a Course of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy Combined With Venlafaxine on Insomnia Symptoms in Elderly Depressed Patients.” In J Clin Psychiatry, Vol. 79, 2018. https://doi.org/10.4088/JCP.16m11089.
McCall, W. Vaughn, et al. “Effects of a Course of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy Combined With Venlafaxine on Insomnia Symptoms in Elderly Depressed Patients.J Clin Psychiatry, vol. 79, no. 2, 2018. Pubmed, doi:10.4088/JCP.16m11089.
McCall WV, Lisanby SH, Rosenquist PB, Dooley M, Husain MM, Knapp RG, Petrides G, Rudorfer MV, Young RC, McClintock SM, Mueller M, Prudic J, Greenberg RM, Weiner RD, Bailine SH, Riley MA, McCloud L, Kellner CH, CORE/PRIDE Work Group. Effects of a Course of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy Combined With Venlafaxine on Insomnia Symptoms in Elderly Depressed Patients. J Clin Psychiatry. 2018.

Published In

J Clin Psychiatry

DOI

EISSN

1555-2101

Publication Date

2018

Volume

79

Issue

2

Location

United States

Related Subject Headings

  • Venlafaxine Hydrochloride
  • Treatment Outcome
  • Sleep Initiation and Maintenance Disorders
  • Severity of Illness Index
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Male
  • Humans
  • Female
  • Electroconvulsive Therapy