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Longitudinal Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Pharmacotherapy in Major Depressive Disorder in Older Adults: Phase 2 of the PRIDE Study.

Publication ,  Journal Article
Lisanby, SH; McClintock, SM; McCall, WV; Knapp, RG; Cullum, CM; Mueller, M; Deng, Z-D; Teklehaimanot, AA; Rudorfer, MV; Bernhardt, E; Prudic, J ...
Published in: Am J Geriatr Psychiatry
January 2022

OBJECTIVE: There is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study. METHOD: After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test). RESULTS: With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility. CONCLUSION: To our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression.

Duke Scholars

Published In

Am J Geriatr Psychiatry

DOI

EISSN

1545-7214

Publication Date

January 2022

Volume

30

Issue

1

Start / End Page

15 / 28

Location

England

Related Subject Headings

  • Venlafaxine Hydrochloride
  • Treatment Outcome
  • Middle Aged
  • Lithium
  • Humans
  • Geriatrics
  • Electroconvulsive Therapy
  • Depressive Disorder, Major
  • Aged
  • 5203 Clinical and health psychology
 

Citation

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Lisanby, S. H., McClintock, S. M., McCall, W. V., Knapp, R. G., Cullum, C. M., Mueller, M., … Prolonging Remission in Depressed Elderly (PRIDE) Work Group. (2022). Longitudinal Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Pharmacotherapy in Major Depressive Disorder in Older Adults: Phase 2 of the PRIDE Study. Am J Geriatr Psychiatry, 30(1), 15–28. https://doi.org/10.1016/j.jagp.2021.04.006
Journal cover image

Published In

Am J Geriatr Psychiatry

DOI

EISSN

1545-7214

Publication Date

January 2022

Volume

30

Issue

1

Start / End Page

15 / 28

Location

England

Related Subject Headings

  • Venlafaxine Hydrochloride
  • Treatment Outcome
  • Middle Aged
  • Lithium
  • Humans
  • Geriatrics
  • Electroconvulsive Therapy
  • Depressive Disorder, Major
  • Aged
  • 5203 Clinical and health psychology