Magazine article Clinical Psychiatry News

Protocol Modifications May Enhance ECT. (Reductions in Side Effects, Relapse)

Magazine article Clinical Psychiatry News

Protocol Modifications May Enhance ECT. (Reductions in Side Effects, Relapse)

Article excerpt

NEW YORK--Electroconvulsive therapy remains the most powerful treatment for depression. But problems with the modality involve trade-offs between efficacy and side effects, and high rates of relapse after termination.

Refining the administration of ECT, including modified dosage parameters and coordinated combination with pharmacotherapy, may improve the technique's efficiency, Dr. Sarah Lisanby said at a conference on depression sponsored by Columbia University.

Other ways of applying electrical stimulation to the brain, now under investigation, may provide more precisely targeted alternatives to ECT, said Dr. Lisanby, director of the transcranial magnetic stimulation laboratory at the university.

ECT is highly effective, even for depression that has failed repeatedly to respond to medication. But relapse is frequent. Most often, relapse occurs within 6 months of treatment. As is the case with pharmacotherapy, patients with residual symptoms are at greatest risk.

One strategy that may reduce relapse is tapering rather than discontinuing the treatment abruptly after achieving remission. "ECT is the only modality for depression that is stopped as soon as it starts to work," Dr. Lisanby said.

As with medication, the risk of rebound is likely to be reduced if the treatment is withdrawn gradually for example from a therapeutic schedule of three sessions per week, to two, to one, she said.

Medication after completion of ECT has been shown to reduce relapse rates: In one series, 84% of patients on placebo relapsed within 6 months, compared with 60% who were maintained on nortriptyline and 39% on nortriptyline and lithium.

The effectiveness of this approach might be optimized by beginning antidepressant therapy toward the end of the ECT series to provide a "head start on relapse prevention." This would be particularly valuable during the high-risk 6-month period in which drugs, if initiated at ECT termination, would otherwise be just kicking in, she said at the conference, also sponsored by New York State Psychiatric Institute. …

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