Reports from the Field: Drug therapy keeps depression away
Reports from the Field
Drug therapy keeps depression away
Drug therapy effectively prevents relapse of major depression following electroconvulsive therapy (ECT), according to a recent study in the Journal of the American Medical Association.
Previous studies indicate that ECT is highly effective for treatment of major depression but that patients experience a high rate of relapse after discontinuation of ECT. A randomized, double-blind, placebo-controlled trial of 290 patients with unipolar major depression who had completed an open ECT treatment phase were included in this study. Of the 290, 159 patients met research criteria for relapsing depression after discontinuation of ECT. During the 24-week study, patients were randomly selected to receive placebo, nortriptyline, or a combination of nortriptyline and lithium. Findings include:
- The relapse rate for the placebo group was 84% compared to 60% for the nortriptyline group and 39% for the nortriptyline/lithium group.
- All but one instance of relapse in the nortriptyline/lithium group occurred within five weeks of ECT discontinuation.
- Relapse continued throughout the 24-week treatment period in the placebo and nortriptyline-only groups.
Researchers conclude that without active treatment virtually all patients relapse within six months of stopping ECT. Monotherapy with nortriptyline, they add, has limited efficacy.
[See: Sackheim HA, Haskett RF, Mulsant BH, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy. JAMA 2001; 285(10):1299-1307.]
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