Author:

Keywords:

ECT, depression, Science & Technology, Life Sciences & Biomedicine, Psychiatry, MAJOR DEPRESSION, DOUBLE-BLIND, PREDICTORS, EFFICACY, LIFE, PREVALENCE, AGE, Aged, Antidepressive Agents, Second-Generation, Cyclohexanols, Depressive Disorder, Major, Electroconvulsive Therapy, Female, Humans, Male, Nortriptyline, Remission Induction, Time Factors, Treatment Outcome, Venlafaxine Hydrochloride, 11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences, 32 Biomedical and clinical sciences, 42 Health sciences, 52 Psychology

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.