Acute Course Of Electroconvulsive Therapy Research Articles

ECT Remission Rates in Psychotic Versus Nonpsychotic Depressed Patients: A Report from CORE

To compare the relative efficacy of electroconvulsive therapy (ECT) in psychotic and nonpsychotic patients with unipolar major depression. The outcome of an acute ECT course in 253 patients with nonpsychotic (n = 176) and psychotic (n = 77) unipolar major depression was assessed in the first phase of an ongoing National Institute of Mental Health-supported four-hospital collaborative study of continuation treatments after successful ECT courses. ECT was administered with bilateral electrode placement at 50% above the titrated seizure threshold. The remission criteria were rigorous: a score <or=10 on the 24-item Hamilton Rating Scale for Depression (HRSD) after 2 consecutive treatments, and a decrease of at least 60% from baseline. The overall remission rate was 87% for study completers. Among these, patients with psychotic depression had a remission rate of 95% and those with nonpsychotic depression, 83%. Improvement in symptomatology, measured by the HRSD, was more robust and appeared sooner in the psychotic patients compared with the nonpsychotic patients. Bilateral ECT is effective in relieving severe major depression. Remission rates are higher and occur earlier in psychotic depressed patients than in nonpsychotic depressed patients. These data support the argument that psychotic depression is a distinguishable nosological entity that warrants separate treatment algorithms.

The effects of electroconvulsive therapy on melatonin.

Although several studies have investigated the impact of various antidepressant medications on melatonin, there are no published reports addressing the effects of electroconvulsive therapy (ECT). Melatonin's major urinary metabolite, 6-sulfatoxymelatonin (6MT), was measured before and after an acute course of ECT. Fourteen subjects diagnosed with major depression who had failed prior pharmacologic therapy were enrolled. 6MT excretion was measured using an enzyme-linked immunosorbent assay test in 24 hour samples separated into daytime and nighttime components. Hamilton Rating Scale for Depression scores showed a significant improvement (p < 0.0001). Data analysis using the Wilcoxon signed rank test demonstrated a significant decrease in 24 hour 6MT post-ECT (p < 0.016) and daytime 6MT (p < 0.008). These results demonstrate an association between a therapeutic response to ECT and decrease in endogenous melatonin production.

ECT in Elderly Patients With Schizophrenia

Five female patients with chronic schizophrenia and schizoaffective disorder received electroconvulsive therapy (ECT). Patients were 58 to 74 years old when ECT began. Three patients followed the acute course of ECT with a course of maintenance ECT. Four patients were considered treatment-resistant to medication. One patient objected to any use of medication and opted for ECT when she became psychotic. Four patients received concurrent antipsychotic medication during and after the course of ECT. All five patients experienced improvement in their psychosis.

ECT in Elderly Patients With Schizophrenia

Five female patients with chronic schizophrenia and schizoaffective disorder received electroconvulsive therapy (ECT). Patients were 58 to 74 years old when ECT began. Three patients followed the acute course of ECT with a course of maintenance ECT. Four patients were considered treatment-resistant to medication. One patient objected to any use of medication and opted for ECT when she became psychotic. Four patients received concurrent antipsychotic medication during and after the course of ECT. All five patients experienced improvement in their psychosis. Five female patients with chronic schizophrenia and schizoaffective disorder received electroconvulsive therapy (ECT). Patients were 58 to 74 years old when ECT began. Three patients followed the acute course of ECT with a course of maintenance ECT. Four patients were considered treatment-resistant to medication. One patient objected to any use of medication and opted for ECT when she became psychotic. Four patients received concurrent antipsychotic medication during and after the course of ECT. All five patients experienced improvement in their psychosis.