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Prevention of Relapse With Maintenance Electroconvulsive Therapy in Elderly Patients With Major Depressive Episode

Rapinesi, Chiara MD*†; Kotzalidis, Georgios Demetrios MD*; Serata, Daniele MD*†; Del Casale, Antonio MD*; Scatena, Paola MD*†; Mazzarini, Lorenzo MD*†; Caccia, Federica MD*; Brugnoli, Roberto MD*; Carbonetti, Paolo MD; Fensore, Claudio MD; Girardi, Paolo MD*†

Journal of ECT:
doi: 10.1097/YCT.0b013e31826d369a
Case Reports
Abstract

Objectives: To evaluate the effectiveness and safety of maintenance electroconvulsive therapy (mECT) in elderly patients with treatment-resistant Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive episode.

Methods: Seven elderly patients with treatment-resistant major depressive episode were treated with a complete ECT cycle. Thereafter, they received one monthly ECT session as maintenance for 1 year. Response to treatment was defined as at least a 50% drop from baseline on the Hamilton Depression Rating Scale (HamD) and remission as not meeting criteria for major depression, a HamD score of 7 or less, and Clinical Global Impressions—Severity of Illness score of 1. We compared their response with the response of 7 elderly patients with treatment-resistant major depression who were treated with a full cycle of ECT but did not receive mECT (non-mECT). We compared the 2 groups for the number of relapses or recurrences of major depressive episodes after remission was achieved; a relapse or a recurrence occurred when HamD scores were 14 or higher, or when Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision major depressive episode criteria were met, or when Clinical Global Impressions—Severity of Illness score was 3 or higher and increased by at least 2 points from response/remission.

Results: The mECT group (4 women and 3 men; mean age, 73 years) had significantly less mean relapses/recurrences (0 vs 1.57) and hospitalizations (0 vs 1) and received less drug treatment than the nonMECT group (similar for age and sex composition) during the 12-month follow-up period. All patients with mECT improved during treatment and did not relapse.

Conclusions: Maintenance ECT protected elderly patients from recurrent depressive episodes from relapsing/recurring more than standard ECT.

Author Information

From the *NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy and †Department of Neuropsychiatry, Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy.

Received for publication July 10, 2012; accepted August 2, 2012.

Reprints: Daniele Serata, MD, Psychiatry Unit, NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University School of Medicine and Psychology, Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy (e-mail: seratadaniele@gmail.com).

Paolo Girardi has in the past 3 years received research support from Lilly and Janssen; has participated in advisory boards for Lilly, Organon, Pfizer, and Schering; and received honoraria from Lilly and Organon. All other authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in, or financial conflict with, the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was used in the production of this manuscript.

© 2013 Lippincott Williams & Wilkins, Inc.