Continuation Pharmacotherapy Research Articles

PP.13.09] THE EFFECTS OF BAROREFLEX ACTIVATION THERAPY ON BLOOD PRESSURE AND SYMPATHETIC FUNCTION IN PATIENTS WITH REFRACTORY HYPERTENSION – THE RATIONALE AND DESIGN OF THE NORDIC BAT STUDY

Objective: Baroreflex activation therapy (BAT) modulates the autonomic nervous system to restore sympathovagal balance. The aim of this study is to explore the effects of BAT on hypertension in patients with refractory (true resistant) hypertension (RH). Design and method: This academic (independent of industry support) randomized, double-blind, 1:1 parallel-design clinical trial will include 100 patients with RH from six hypertension centers in the Nordic countries. A Barostim Neo® System will be implanted and after 1 month of stabilization patients will be randomized to either BAT for 16 months or continuous pharmacotherapy (BAT off) for 8 months followed by the BAT for 8 months (Figure). Blood and urine samples will be drawn and measures of arterial and cardiac function and structure, and of autonomic function will be performed at randomization, and after 8 and 16 months. Eligible patients will be 18–70 years and have a daytime systolic ambulatory blood pressure (ABMP) of 145 mmHg or more, and/or a daytime diastolic ABMP of 95 mmHg or more, after witnessed intake of antihypertensive treatment (including at least 3 antihypertensive drugs, preferably a diuretic), with no changes in medication for a minimum of 4 weeks prior to enrolment. Patients with secondary causes of hypertension, severe renal insufficiency, untreated sleep apnea, pregnancy, type 1 diabetes, alcohol/drug abuse, or psychiatric illnesses, other than sinus rhythm (controlled atrial fibrillation is not a contraindication), uncontrolled systolic heart failure, aortic stenosis, and a cardiovascular event 3 within months before enrolment will be excluded. Results: The primary end point is to test whether BAT reduces 24-hour systolic ABMP at 8 months of follow-up compared to pharmacotherapy. Secondary/tertiary endpoints are the effects of BAT on home and office blood pressure, measures of autonomic function, arterial and cardiac structure and function during follow-up, and extended long-term follow-up. Two patients have been included in the study so far. An interim analysis will be done after 50 patients. Conclusions: This initiative will increase the understanding of the mechanisms and role of BAT in the treatment of RH.

Does physician specialty affect persistence to pharmacotherapy among patients with overactive bladder syndrome?

We compared persistence on overactive bladder (OAB) pharmacotherapy in patients treated in the Female Pelvic Medicine and Reconstructive Surgery (FPMRS) department compared with patients treated in the Internal Medicine (IM) and General Urology (GU) departments within an integrated health-care system. We hypothesized that persistence would be higher among FPMRS patients. This was a retrospective cohort study. Patients with at least one prescription for OAB between January 2003 and July 2014 were identified. Demographic, prescription and treatment specialty data and data on the use of third-line therapies were collected. The primary outcome was persistence, defined as days on continuous pharmacotherapy. Discontinuation was defined as a treatment gap of ≥45days. Discontinuation-free probabilities were calculated using the Kaplan-Meier method and compared among the specialties. Predictors of persistence were estimated using logistic regression with adjustment for covariates. Pearson correlation coefficients were calculated to identify risk associations. A total of 252 subjects were identified. At 12weeks, 6months and 1year, FPMRS patients had the highest persistence rates of 93%, 87% and 79% in contrast to 72%, 68% and 50% in GU patients, and 83%, 71% and 63% in IM patients (p = 0.006, p = 0.007, p = 0.001, respectively). The median persistence in FPMRS patients was 738days, in GU patients 313days and in IM patients 486days (p = 0.006). Of the FPMRS patients, 61% switched to at least a second medication, as compared to 27% of IM patients and 14% of GU patients (p < 0.0001). Persistence on OAB pharmacotherapy was higher among FPMRS patients than among GU and IM patients in this community setting. These results suggest that persistence is higher under subspecialist supervision.

English

Schizophrenia is a life-long disorder that requires continuous pharmacotherapy. About 10 to 30% of patients with schizophrenia show poor response to antipsychotic medication alone, therefore concomitant medication is often used. The rationale for the addition of concomitant medication is often unclear and based on limited evidence. The most frequently prescribed concomitant medications in the treatment of schizophrenia include anticholinergic medication, antidepressants, anxiolytics for example, benzodiazepines, lithium and anticonvulsant medication for example, valproex. Indications for adding these medications to antipsychotic treatment regimens vary from controlling specific symptoms associated with schizophrenia for example, anxiety symptoms, aggressive behavior and suicidality, to managing adverse effects for example, parkinsonian side effects caused by antipsychotic medication. Although there is a need for concomitant medication in the treatment of schizophrenia, each patient needs to be assessed individually since the use of concomitant medication can also have negative treatment implications, for example an increase in the occurrence of adverse effects and drug interactions. Due to the diversity of the disease profile of schizophrenia, no one adjunctive treatment benefits all patients, therefore the choice of specific treatment is best guided by the clinical characteristics and presentation of the individual patient. The aim of this paper is thus to present a qualitative review of the literature. Key words: Schizophrenia, concomitant medication, antipsychotics, anticholinergics, antidepressants.

Improving relapse prevention after successful electroconvulsive therapy for patients with severe depression: completed audit cycle involving 102 full electroconvulsive therapy courses in West Sussex, United kingdom.

The aim of this study was to determine whether current guidance or consensus regarding continuation pharmacotherapy after successful electroconvulsive therapy (ECT) was being followed by referring clinicians in West Sussex, United Kingdom. A complete audit cycle examining psychotropic medication after successful ECT for patients with severe depression was performed. Clinical and ECT records (electronic and paper) were reviewed, and relapse rates in the 4 commonly prescribed psychotropic medication groups were compared. The pattern of relapse in the 4 groups was similar for both audits 1 and 2. Taking the 102 patients as a whole, the lowest relapse rates were recorded for patients taking a combination of an antidepressant and lithium (16% relapsed within 6 months of successful ECT). Patients taking a combination of antipsychotic and antidepressants fared the worst with 75% relapse rate. This was followed by those taking a combination of antidepressant and a mood stabilizer (other than lithium) (69%). Patients taking antidepressant(s) only were associated with a relapse rate of 60%. Audit 2 demonstrated that clinicians did not change their prescribing practices for their patients after successful ECT despite the efforts made in widely disseminating the results of audit 1. In particular, there was no increase in the use of lithium. Not all psychotropic medication prescribing for patients receiving ECT for depression followed available and current guidance or consensus. More needs to be done to understand the reasons for the reluctance to use lithium if relapse rates after ECT are to improve.

What happens to mental health treatment during pregnancy? Women's experience with prescribing providers.

This exploratory study completed interviews with 25 depressed pregnant women who had prior depression, and when becoming pregnant, were receiving depression medication or tried to get mental health care. Seventy one percent of women were more than 25 weeks gestation at the time of the interview. Thirty-five percent of women were not receiving treatment. While 94 % told their provider of their pregnancy, 36 % had no opportunity to discuss the risks and benefits of continued pharmacotherapy; 42 % had no opportunity to continue pharmacotherapy. Some providers may be reluctant to treat depressed pregnant women, creating a potential barrier to their receipt of needed care.

A Primate Model of the Effects of Childhood Antidepressant Treatment

A Primate Model of the Effects of Childhood Antidepressant Treatment

Terminal remission is possible in some patients with juvenile myoclonic epilepsy without therapy.

Juvenile myoclonic epilepsy is considered to be a chronic disease requiring lifelong antiepileptic treatment. The aim of this study was both to identify factors predicting the kind of seizure control and to investigate the outcome in patients after therapy withdrawal. The study included 87 patients (49 female, 38 male), aged from 17.5 to 43.5 years, referred to our Department between 1987 and 2008, with the seizure onset at the age of 14.3±2.9, and followed up for 13.3±5.8 years on average (from 5 to 23 years). Sixty seven (77.0%) patients were fully controlled; whereas 13.8% had persistent seizures and 9.2% showed pseudoresistance. The combination of three seizure types and focal electroencephalogram features were independent factors of poor seizure control. Therapy was discontinued in 34 patients either by the treating physician (in 21 patients) or by the patients themselves (in 13 cases). In 18 subjects, all seizure types relapsed after 1.1 year on average (from 7 days to 4 years) and therapy was resumed in them. All patients but three (10/13), who stopped the treatment themselves, experienced recurrences. Seizure freedom off drugs was recorded in 10.3% patients. Nonintrusive myoclonic seizures recurred in 0.5-3 years as their only seizure type in four patients, but without reintroducing medication in three patients. Combination of seizure types and focal electroencephalogram features are significant factors of pharmacoresistancy. Continuous pharmacotherapy is required in majority of patients, although about 10% of them appear to have permanent remission without therapy in adolescence.

Data Support Shock Therapy for Major Mood Disorders

Data Support Shock Therapy for Major Mood Disorders

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

High rates of early relapse following electroconvulsive therapy (ECT) are typically reported in the literature. Current treatment guidelines offer little information to clinicians on the optimal nature of maintenance therapy following ECT. The aim of this study was to provide a systematic overview of the existing evidence regarding post-ECT relapse. A keyword search of electronic databases was performed for studies appearing in the peer-reviewed literature before January 2013 reporting on relapse rates in responders to an acute course of ECT administered for a major depressive episode. Meta-analyses were performed where appropriate. Thirty-two studies with up to 2 years' duration of follow-up were included. In modern era studies of continuation pharmacotherapy, 51.1% (95% CI=44.7-57.4%) of patients relapsed by 12 months following successful initial treatment with ECT, with the majority (37.7%, 95% CI=30.7-45.2%) relapsing within the first 6 months. The 6-month relapse rate was similar in patients treated with continuation ECT (37.2%, 95% CI=23.4-53.5%). In randomized controlled trials, antidepressant medication halved the risk of relapse compared with placebo in the first 6 months (risk ratio=0.49, 95% CI=0.39-0.62, p<0.0001, number needed to treat=3.3). Despite continuation therapy, the risk of relapse within the first year following ECT is substantial, with the period of greatest risk being the first 6 months. The largest evidence base for efficacy in post-ECT relapse prevention exists for tricyclic antidepressants. Published evidence is limited or non-existent for commonly used newer antidepressants or popular augmentation strategies. Maintenance of well-being following successful ECT needs to be improved.

Physical health of patients with bipolar disorder

Bipolar disorder is a chronic, typically early onsetting group of mental disorders with a lifelong risk of relapse. It is characterized by recurrent periods of depression and pathologically elevated mood consisting of increased energy and activity during which patients may experience sleep loss, over-confidence, impaired concentration, extreme talkativeness, and engage in irresponsible risk-taking behavior. As a result, it is often problematic to undertake usual activities and maintain interpersonal relationships (World Health Organization [WHO], 2001). An estimated 2.4% of the world’s population suffer from some form of bipolar disorder, with a lifetime prevalence of 0.6% for bipolar I disorder and 0.4% for bipolar II disorder, while 1.4% of the total population has a lifetime prevalence of subsyndromal bipolar disorder (Merikangas et al., 2011). Bipolar disorders are categorized into bipolar I and bipolar II depending on a patient history of major depressive and hypomanic episodes only (bipolar II), or depressive and manic episodes in addition to hypomanic and mixed episodes (bipolar I). Subsyndromal symptoms may be diagnosed as bipolar disorder not otherwise specified. Patients with bipolar disorder encounter many difficulties in leading a normal lifestyle, even with the support of family, friends and carers, and therefore tend to have a low quality of life (QoL), which is powerfully influenced by two factors: the nature of mental illness itself and treatment-related comorbidities. Features of social disability that may trouble patients with bipolar disorder include problems in developing and sustaining friendships and difficulties in maintaining intimate relationships with a partner. Furthermore, the inability to manage money, housework, and coping with an emergency (Kai and Crosland, 2001) impedes a normal lifestyle. Possibly as a consequence of poor QoL, “self

Pharmacological Strategies in the Prevention of Relapse After Electroconvulsive Therapy

To determine whether starting antidepressant medication at the start of electroconvulsive therapy (ECT) reduces post-ECT relapse and to determine whether continuation pharmacotherapy with nortriptyline (NT) and lithium (Li) differs in efficacy or adverse effects from continuation pharmacotherapy with venlafaxine (VEN) and Li. During an acute ECT phase, 319 patients were randomized to treatment with moderate dosage bilateral ECT or high-dosage right unilateral ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN. Of 181 patients to meet post-ECT remission criteria, 122 (67.4%) participated in a second continuation pharmacotherapy phase. Patients earlier randomized to NT or VEN continued on the antidepressant, whereas patients earlier randomized to placebo were now randomized to NT or VEN. Lithium was added for all patients who were followed until relapse or 6 months. Starting an antidepressant medication at the beginning of the ECT course did not affect the rate or timing of relapse relative to starting pharmacotherapy after ECT completion. The combination of NT and Li did not differ from VEN and Li in any relapse or adverse effect measure. Older age was strongly associated with lower relapse risk, whereas the type of ECT administered in the acute phase and medication resistance were not predictive. Across sites, 50% of the patients relapsed, 33.6% continued in remission 6 months after ECT, and 16.4% dropped out. Starting an antidepressant medication during ECT does not affect relapse, and there are concerns about administering Li during an acute ECT course. Nortriptyline and VEN were equally effective in prolonging remission, although relapse rates after ECT are substantial despite intensive pharmacology. As opposed to the usual abrupt cessation of ECT, the impact of an ECT taper should be evaluated.

Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis

ObjectivesAlthough cognitive behaviour therapy (CBT) and pharmacotherapy are equally effective in the acute treatment of adult depression, it is not known how they compare across the longer term. In this...

A Comparison of the E-BEHAVE-AD, NBRS, and NPI in Quantifying Clinical Improvement in the Treatment of Agitation and Psychosis Associated With Dementia

The aim of this study is to compare the Empirical Behavioral Rating Scale (E-BEHAVE-AD), Neurobehavioral Rating Scale (NBRS), and Neuropsychiatric Interview (NPI) in detecting behavioral disturbance and psychotic symptoms in dementia and characterizing changes in response to treatment. Eighty-seven subjects in the randomized controlled trial "Continuation Pharmacotherapy for Agitation of Dementia" were included in this analysis. We compared the detection in, and changes of, both agitation and psychosis, using these three instruments. A receiver operating characteristic analysis was performed to compare the performance of the three instruments in detecting global improvement. The instruments were equally likely to detect agitation. The NBRS was most likely to detect psychosis. Although the NPI best detected improvement in agitation, the instruments were equal for detecting improvement in psychosis. In the receiver operating characteristic analysis for overall clinical improvement in response to treatment, there were no differences in the areas under the correlated curves for the three instruments, but they demonstrated different sensitivity and specificity at different cutoff points for target symptom reduction. The E-BEHAVE-AD performed best at a cut point of 30% target symptom reduction and the NBRS and NPI both performed best at 50%. The E-BEHAVE-AD, NBRS, and NPI were more similar than different in characterizing symptoms but differed in detecting response to treatment. Differences in sensitivity and specificity may lead clinicians to prefer a specific instrument, depending on their goal and the expected magnitude of response to any specific intervention.

頬部腫脹を契機に診断されたネフローゼ症候群を伴った木村病の1例

Kimura's disease is a rare benign chronic granulomatous lesion of soft tissue or lymph nodes of the head and neck region and is characterized by eosinophilia and an increased serum IgE level in peripheral blood. Kimura's disease is reported to be associated with renal disturbance, but the pathogenesis of this association remains obscure. We report a case of Kimura's disease associated with nephrotic syndrome.Two years before the first visit, the patient complained of a mass with painless swelling in the left cheek and on both sides of the neck. Remission and relapse of the mass occurred several times in association with the dose of steroids administered for nephrotic syndrome. Laboratory investigations revealed peripheral blood eosinophilia and an elevated serum IgE level. The mass in the cheek was surgically enucleated for esthetic purposes and definitive diagnosis. Histopathological examination indicated eosinophilic lymphfolliculoid granuloma; thus, Kimura's disease was finally diagnosed. The patient has received continuous pharmacotherapy with steroids and immunosuppressive drugs; the mass shrank on both sides of the neck, and good clinical status has been maintained.

LONG-TERM EFFICACY OF REPEATED DAILY PREFRONTAL TRANSCRANIAL MAGNETIC STIMULATION (TMS) IN TREATMNT-RESISTANT DEPRESSION

A few studies have examined the durability of transcranial magnetic stimulation (TMS) antidepressant benefit once patients remitted. This study examined the long-term durability of clinical benefit from TMS using a protocol-specified TMS taper and either continuation pharmacotherapy or naturalistic follow-up.Patients were remitters from an acute double-blind sham-controlled trial of TMS (n = 18), or from an open-label extension in patients who did not respond to the acute trial (n = 43). Long-term durability of TMS acute effect was examined in remitters over a 12-week follow-up. Relapse, defined as 24-item Hamilton Depression Rating Scale (HDRS-24) ≥20, was the primary outcome.Of 61 remitters in the acute trial, five entered naturalistic follow-up and 50 entered the TMS taper. Thirty-two patients completed TMS taper and 1-, 2-, and 3-month follow-up. At 3-month visit, 29 of 50 (58%) were classified as in remission (HDRS-24 ≤10), two of 50 (4%) as partial responders (30%≤ HDRS-24 reduction <50% from baseline), and one of 50 (2%) met criteria for relapse. During the entire 3-month follow-up, five of the 37 patients relapsed (relapse rate = 13.5%), but four of them regained remission by the end of the study. The average time to relapse in these five patients was 7.2 ± 3.3 weeks. Patients who relapsed had higher depression scores at 1 month.While one third of the sample was lost to follow-up, our results demonstrate that most patients contributing to observations experienced persistence of benefit from TMS followed by pharmacotherapy or no medication. Longer follow-up and more rigorous studies are needed to explore the true long-term durability of remission produced by TMS.

Health-Related Quality of Life in a Clinical Trial of ECT Followed by Continuation Pharmacotherapy

: 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. : 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. : 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. : 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.

A Randomized Controlled Trial Comparing the Memory Effects of Continuation Electroconvulsive Therapy Versus Continuation Pharmacotherapy: Results From the Consortium for Research in ECT (CORE) Study

A Randomized Controlled Trial Comparing the Memory Effects of Continuation Electroconvulsive Therapy Versus Continuation Pharmacotherapy: Results From the Consortium for Research in ECT (CORE) Study

Combination of Pharmacotherapy With Electroconvulsive Therapy in Prevention of Depressive Relapse

Relapse rates after electroconvulsive therapy (ECT) remain high with standard treatments. We aimed to test the efficacy of an early administered continuation pharmacotherapy (c-pharm early) strategy in prevention of post-ECT relapse. A 20-week, randomized, double-blind, placebo-controlled trial. Patients aged 18 to 65 years diagnosed with Diagnostic and Statistical Manual of Mental Disorders major depressive disorder, with or without psychotic features, with initial Montgomery-Asberg Depression Rating Scale scores higher than 22, underwent 8 bilateral ECT sessions (2 per week). Randomization to c-pharm early, c-pharm late, and placebo groups in 2:2:1, respectively, was performed at the completion of the fourth ECT session. After randomization, subjects in the c-pharm early group were given sertraline at 150 mg/d. Subjects in the c-pharm late group were first given placebo, which was substituted with sertraline at 150 mg/d at the completion of the eight ECT. Relapse was defined as a Montgomery-Asberg Depression Rating Scale score of 16 or higher. Seventy-three percent of the patients responded to the given treatment. The relapse rates were 12.5% in the c-pharm early group, 28% in the c-pharm late group, and 67% in the placebo group (P = 0.09). The c-pharm early strategy resulted in significantly lower relapse rates and longer well time compared with the placebo (P = 0.04). When the trend with the initiation of the c-pharm intervention was investigated in the 3 groups with equally spaced trend weights, the time of initiation was found to have a significant effect on the probability of the remaining well (P = 0.03). Comparative efficacy of c-pharm early and late strategies in providing improved protection against post-ECT relapse of major depressive disorder needs to be further explored.

A Randomized Controlled Trial of Antidepressant Continuation for Major Depression Following Traumatic Brain Injury

This study examines whether continuation therapy with citalopram can prevent a relapse following remission of major depression due to traumatic brain injury. After 65 subjects with DSM-IV-diagnosed major depression following traumatic brain injury were treated with open-label citalopram (20 mg to 50 mg/d), 25 subjects (38.5%) met criteria for remission. Of those, 21 (84.0%) were randomly assigned to either same-dose citalopram or placebo and followed monthly over 40 weeks. Remission was defined as a Hamilton Depression Rating Scale (HDRS) score of ≤ 7 or a Clinical Global Impressions-Improvement rating of "much improved" or better. The main outcome variable was the presence of relapse, as defined by meeting criteria for major depressive episode according to the DSM-IV and an HDRS score ≥ 16. Data were collected from February 16, 2005, to May 5, 2008. Ten subjects were randomly assigned to citalopram and 11 to placebo. There were 3 dropouts, including 1 for adverse drug effects (diarrhea). Relapse occurred in 11 subjects (52.4%), with a mean ± SD time to relapse of 23.52 ± 16.6 weeks. The groups did not differ in relapse rates (drug: 50.0% [5/10] vs placebo: 54.5% [6/11], Fisher exact test, P = .835) or time to relapse (log rank test χ² = 0.148, P = .700). The present study suggests important limitations of continuation pharmacotherapy in the prevention of relapse of major depression following traumatic brain injury. clinicaltrials.gov Identifier: NCT00162916.

A Randomized Controlled Trial Comparing the Memory Effects of Continuation Electroconvulsive Therapy Versus Continuation Pharmacotherapy

To compare the memory effects of continuation electroconvulsive therapy (C-ECT) versus continuation pharmacologic intervention (C-PHARM) at 12 and 24 weeks after completion of acute electroconvulsive therapy (ECT). Eighty-five patients with Structured Clinical Interview for DSM-IV-diagnosed unipolar major depressive disorder, enrolled in a multisite, randomized, parallel-design trial conducted at 5 academic medical centers from 1997 to 2004, who had remitted with an acute course of bilateral ECT and remained unrelapsed through 24 weeks of continuation therapy, were included in this analysis. They were randomly assigned to C-ECT (10 treatments) or nortriptyline plus lithium (monitored by serum blood levels) for 24 weeks. Objective neuropsychological measures of retrograde and anterograde memory and subjective assessment of memory were obtained at baseline, 12 weeks, and 24 weeks. The Rey Auditory-Verbal Learning Test and the Autobiographical Memory Interview were the primary outcome measures. The C-PHARM group showed a greater group difference (P < .01) for baseline to 12-week change for the Autobiographical Memory Interview. No other memory measures showed group differences for change scores from baseline to 12 weeks. Groups showed no baseline to 24-week change-score differences on any of the memory measures. For both groups, 12-week objective anterograde memory scores (eg, Auditory-Verbal Learning Test percent retention P = .0001; Rey-Osterrieth Complex Figure or Taylor Figure percent retention P < .002) and 24-week subjective memory scores were significantly improved (Squire Subjective Memory Questionnaire P < .02) over baseline. This result reflects the apparent resolution of a presumed decrement in anterograde memory associated with acute ECT preceding this study. The finding of no memory outcome differences between unrelapsed recipients of C-ECT and C-PHARM is consistent with clinical experience. Memory effects have only a small role in the choice between C-ECT and C-PHARM.