Objective: To examine the determinants of health-related quality of life (HRQOL) immediately after a clinical trial of electroconvulsive therapy (ECT) for major depression and then again after 24 weeks of a continuation pharmacotherapy in a clinical trial comparing nortriptyline (NT) plus lithium (Li) versus venlafaxine (VEN) plus Li.
Method: During acute ECT, 184 patients randomized to treatment with moderate-dosage bilateral (BL) ECT or high-dosage right unilateral (RUL) ECT completed the Medical Outcomes Study Short Form-36 (SF-36) as a measure of HRQOL before and immediately after ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN. Seventy-four of these met remission criteria and agreed to be further randomized to 24 more weeks of VEN + Li versus NT + Li for relapse prevention and completed a final SF-36. Cognitive testing was also completed.
Results: Scores from SF-36 were low before ECT, and the SF-36 subscales reflecting mental health were particularly low. Right unilateral electrode placement was associated with better SF-36 scores immediately after ECT, even after controlling for improvement in depression. Medication assignment during ECT (VEN, NT, or placebo) was not related to immediate HRQOL outcome, and cognitive performance was not related to immediate HRQOL. Remission immediately after ECT was associated with robust improvement in SF-36 scores compared with those who did not remit. Remission status remained a strong predictor of HRQOL 24 weeks after ECT, and sustained remitters showed additional gains in HRQOL 24 weeks after ECT. Electrode placement and medication assignment were not predictors at 24 weeks.
Conclusions: Using state-of-the-art delivery of acute ECT and continuation antidepressant medication, HRQOL improves remarkably after ECT, and this improvement shows further gains with those persons who sustain remission. Health-related QOL is superior with RUL versus BL ECT in the immediate post-ECT period, but at 24-weeks HRQOL has absent or inconsistent relationship with mode of ECT delivery or type of continuation antidepressant pharmacotherapy.
From the *Department of Psychiatry and Behavioral Sciences, Wake Forest University, Winston-Salem, NC; †Western Psychiatric Institute and Clinic and the Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; ‡Department of Psychiatry, Washington University, St. Louis, MO; and §New York State Psychiatric Institute, and Department of Psychiatry, Columbia University,New York, NY.
Received for publication September 8, 2010; accepted November 4, 2010.
Reprints: W. Vaughn McCall, MD, MS, Department of Psychiatry and Behavioral Sciences, Wake Forest University, Winston-Salem, NC (e-mail: firstname.lastname@example.org).
This study was supported in part by grants RO1 MH35636 (Dr Sackeim), RO1 MH61609 (Dr Sackeim), RO1 MH61594 (Dr McCall), RO1 MH61621 (Dr Isenberg), and RO1 MH61591 (Dr Haskett) from the US Public Health Service, Rockville, MD; and a grant from Wyeth Pharmaceuticals for the purchase of the medications used in this study; ECT devices were loaned from MECTA Corporation.