TY - JOUR
T1 - A novel strategy for continuation ECT in geriatric depression
T2 - Phase 2 of the PRIDE study
AU - CORE/PRIDE Work Group
AU - Kellner, Charles H.
AU - Husain, Mustafa M.
AU - Knapp, Rebecca G.
AU - Mccall, W. Vaughn
AU - Petrides, Georgios
AU - Rudorfer, Matthew V.
AU - Young, Robert C.
AU - Sampson, Shirlene
AU - McClintock, Shawn M.
AU - Mueller, Martina
AU - Prudic, Joan
AU - Greenberg, Robert M.
AU - Weiner, Richard D.
AU - Bailine, Samuel H.
AU - Rosenquist, Peter B.
AU - Raza, Ahmad
AU - Kaliora, Styliani
AU - Latoussakis, Vassilios
AU - Tobias, Kristen G.
AU - Briggs, Mimi C.
AU - Liebman, Lauren S.
AU - Geduldig, Emma T.
AU - Teklehaimanot, Abeba A.
AU - Dooley, Mary
AU - Lisanby, Sarah H.
AU - Ahle, Gabriella
AU - Aloysi, Amy S.
AU - Bryson, Ethan
AU - Farber, Kate
AU - Majeske, Matthew
AU - Muller, Elizabeth
AU - Nazarian, Roya
AU - Pasculli, Rosa
AU - Cochran, Ashly
AU - Evans, Laura D.
AU - Friedman, David
AU - Kotbi, Nabil
AU - Lucas, Bryony
AU - Rogers, Arielle
AU - Gubosh, Brittany
AU - Hodges, Chelsea
AU - McCloud, Laryssa
AU - Riley, Mary Anne
AU - Braga, Raphael
AU - Fuentes, Ingrid
AU - Hiranpara, Ketan
AU - Khan, Muhammad
AU - Powers, Carmel
AU - Kung, Simon
AU - Lapid, Maria
N1 - Funding Information:
Supported by NIMH grants U01MH055495, U01MH081362, U01MH086127, U01MH086127, U01MH086130, U01MH08612005, U01MH084241, and U01MH086122.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Objective:Therandomized phase (phase 2) of the Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy and tolerability of continuation ECT plus medication compared with medication alone in depressed geriatric patients after a successful course of ECT (phase 1). Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, augmented with venlafaxine. Phase 2 compared two randomized treatment arms: A medication only arm (venlafaxine plus lithium, over 24 weeks) and an ECT plus medication arm(four continuationECTtreatmentsover1month, plusadditionalECT as needed, using the Symptom-Titrated, Algorithm-Based Longitudinal ECT [STABLE] algorithm, while continuing venlafaxine plus lithium). The intent-To-Treat sample comprised 120 remitters from phase 1. The primary efficacy outcome measure was score on the 24-item Hamilton Depression Rating Scale (HAM-D), and the secondary efficacy outcome was score on the Clinical Global Impressions severity scale (CGI-S). Tolerability as measured by neurocognitive performance (reported elsewhere) was assessed using an extensive test battery; global cognitive functioning as assessed by the Mini-Mental State Examination (MMSE) is reported here. Longitudinal mixed-effects repeated-measures modeling was used to compare ECT plus medication and medication alone for efficacy and global cognitive function outcomes. Results: At 24 weeks, the ECT plus medication group had statistically significantly lower HAM-D scores than the medication only group. The difference in adjustedmean HAM-D scores at study end was 4.2 (95% CI=1.6, 6.9). Significantly more patients in the ECT plus medication group were rated "not ill at all" on the CGI-S compared with the medication only group. There was no statistically significant difference between groups in MMSE score. Conclusions: Additional ECT after remission (here operationalized as four continuation ECT treatments followed by furtherECTonly as needed)wasbeneficial in sustainingmood improvement for most patients.
AB - Objective:Therandomized phase (phase 2) of the Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy and tolerability of continuation ECT plus medication compared with medication alone in depressed geriatric patients after a successful course of ECT (phase 1). Method: PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, augmented with venlafaxine. Phase 2 compared two randomized treatment arms: A medication only arm (venlafaxine plus lithium, over 24 weeks) and an ECT plus medication arm(four continuationECTtreatmentsover1month, plusadditionalECT as needed, using the Symptom-Titrated, Algorithm-Based Longitudinal ECT [STABLE] algorithm, while continuing venlafaxine plus lithium). The intent-To-Treat sample comprised 120 remitters from phase 1. The primary efficacy outcome measure was score on the 24-item Hamilton Depression Rating Scale (HAM-D), and the secondary efficacy outcome was score on the Clinical Global Impressions severity scale (CGI-S). Tolerability as measured by neurocognitive performance (reported elsewhere) was assessed using an extensive test battery; global cognitive functioning as assessed by the Mini-Mental State Examination (MMSE) is reported here. Longitudinal mixed-effects repeated-measures modeling was used to compare ECT plus medication and medication alone for efficacy and global cognitive function outcomes. Results: At 24 weeks, the ECT plus medication group had statistically significantly lower HAM-D scores than the medication only group. The difference in adjustedmean HAM-D scores at study end was 4.2 (95% CI=1.6, 6.9). Significantly more patients in the ECT plus medication group were rated "not ill at all" on the CGI-S compared with the medication only group. There was no statistically significant difference between groups in MMSE score. Conclusions: Additional ECT after remission (here operationalized as four continuation ECT treatments followed by furtherECTonly as needed)wasbeneficial in sustainingmood improvement for most patients.
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U2 - 10.1176/appi.ajp.2016.16010118
DO - 10.1176/appi.ajp.2016.16010118
M3 - Article
C2 - 27418381
AN - SCOPUS:84994111882
SN - 0002-953X
VL - 173
SP - 1110
EP - 1118
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
IS - 11
ER -