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Impacts of Switching Antidepressants After Successful Electroconvulsive Therapy on the Maintenance of Clinical Remission in Patients With Treatment-Resistant Depression: A Chart Review

Nakajima, Shinichiro MD*†; Ishida, Takuto MD†‡; Akaishi, Rei MD†§; Takahata, Keisuke MD†∥; Kitahata, Ryosuke MD†∥; Uchida, Hiroyuki MD, PhD†¶; Suzuki, Takefumi MD, PhD†#; Takeuchi, Hiroyoshi MD*†; Nomura, Kensuke MD; Nakagawa, Atsuo MD; Watanabe, Koichiro MD, PhD; Kashima, Haruo MD, PhD

doi: 10.1097/YCT.0b013e3181a8e2ac
Original Studies

Introduction: There is no consensus regarding whether a previously prescribed, that is, failed, antidepressant should be continued or switched after a successful electroconvulsive therapy (ECT) for the maintenance of clinical remission in patients with treatment-resistant depression (TRD). In this study, we conducted a chart review to examine impacts of the antidepressant switch after the successful ECT on 1-year outcome in patients with TRD.

Materials and Methods: This retrospective chart review included inpatients with TRD (ie, those who failed to respond to adequate trials of 2 distinctly different classes of antidepressants) who showed clinical remission after ECT. Readmission rate and social functioning 6 months and 1 year after the successful ECT were compared between patients who experienced an antidepressant switch and those who continued prior regimen.

Results: Twenty-eight patients (mean age, 59 years; 9 men) were followed-up for 1 year. The patients who changed antidepressants after ECT (n = 7) experienced a readmission significantly less frequent than the others (n = 21) in 1 year (0% vs 43%, P = 0.043). In addition, the former showed significantly better social contacts at 6 months (P = 0.022) and 1 year (P = 0.015). There were no significant differences in baseline characteristics between the 2 groups.

Conclusions: The patients who experienced an antidepressant switch after ECT required a readmission less frequently in 1 year than those who were maintained with the same antidepressant. The findings of this preliminary study suggest that a switch to another antidepressant after successful ECT may be encouraged for the maintenance of clinical remission in patients with TRD.

From the *Oizumi Hospital and †Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo; ‡National Hospital Organization Chiba Medical Center, Chiba; §National Hospital Organization Tokyo Medical Center and ∥Tachikawa Kyosai Hospital, Tokyo, Japan; ¶Centre for Addiction and Mental Health, Toronto, Canada; and #Inokashira Hospital, Tokyo, Japan.

Received for publication November 11, 2008; accepted March 16, 2009.

Reprints: Shinichiro Nakajima, MD, Oizumi Hospital, 6-9-1 Oizumigakuen-cho, Nerima-ku, Tokyo, 186-0005 Japan (e-mail:

There was no funding source for this study.

Some of these data were presented at the annual meeting of the Japanese Society of Clinical Neuropsychopharmacology; October 3-5, 2007; Osaka, Japan.

Within the past 2 years, Dr Nakajima has received a grant from Inokashira Hospital Foundation. Dr Uchida's fellowship has been supported by the Japanese Society of Clinical Psychopharmacology, Pfizer Health Research Foundation, and Mochida Memorial Foundation. Within the past 2 years, he has received grants and manuscript fees from Pfizer and Dainippon Sumitomo Pharmaceutical. Dr Watanabe has received grants and consultant fees from Janssen Pharma, Eli Lilly, Pfizer, GlaxoSmithKline, and Dainippon Sumitomo Pharmaceutical and received a speaker's honoraria from Janssen Pharma, Eli Lilly, Meiji, Astellas Pharma, Yoshitomi, Dainippon Sumitomo Pharmaceutical, Otsuka, Pfizer, and GlaxoSmithKline within the past 2 years.

Drs Ishida, Akaishi, Takahata, Kitahata, Takeuchi, Suzuki, Nomura, Nakagawa, and Kashima have no competing interest to disclose.

© 2009 Lippincott Williams & Wilkins, Inc.