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Randomized Controlled Trial
. 2015 Jan;206(1):67-71.
doi: 10.1192/bjp.bp.114.148213. Epub 2014 Oct 16.

Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication

Harm-Pieter Spaans  1 , Pascal Sienaert  1 , Filip Bouckaert  1 , Julia F van den Berg  1 , Esmée Verwijk  1 , King H Kho  1 , Max L Stek  1 , Rob M Kok  1
Affiliations
Randomized Controlled Trial

Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication

Harm-Pieter Spaans et al. Br J Psychiatry. 2015 Jan.

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.

Aims: To compare the speed of remission using ECT v. medication in elderly in-patients.

Method: 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.

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Comment in

  • More data on speed of remission with ECT in geriatric depression.
    Kellner CH, Geduldig ET, Knapp RG, Young RC, Weiner RD, Greenberg RM, Prudic J, McCall WV, Petrides G, Husain MM, Rudorfer MV, Lisanby SH. Kellner CH, et al. Br J Psychiatry. 2015 Feb;206(2):167. doi: 10.1192/bjp.206.2.167. Br J Psychiatry. 2015. PMID: 25644884 Free PMC article. No abstract available.
  • Authors' reply.
    ResPECT (Research in Psychiatry and ECT) group; Spaans HP, Sienaert P, Bouckaert F, van den Berg JF, Verwijk E, Kho KH, Stek ML, Kok RM. ResPECT (Research in Psychiatry and ECT) group, et al. Br J Psychiatry. 2015 Feb;206(2):167-8. doi: 10.1192/bjp.206.2.167a. Br J Psychiatry. 2015. PMID: 25644885 No abstract available.

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