Earlier Use of Antidepressants, Tapered Doses Reduce Relapse Rate Post ECT. (Dispelling Treatment Misconceptions)

By Mann, Arnold | Clinical Psychiatry News, December 2001 | Go to article overview

Earlier Use of Antidepressants, Tapered Doses Reduce Relapse Rate Post ECT. (Dispelling Treatment Misconceptions)


Mann, Arnold, Clinical Psychiatry News


SANTA FE -- Tapering doses and earlier administration of antidepressants may open the door to fewer relapses after electroconvulsive therapy, Harold Sackeim, Ph.D., said at a symposium on mood disorders sponsored by the University of Arizona.

"Electroconvulsive therapy is the only treatment we have in biological psychiatry that once it works we typically stop it--and we stop it abruptly," said Dr. Sackeim, chief of the department of biologic psychiatry at New York State Psychiatric Institute, New York, and professor of psychiatry and radiology at Columbia University, New York.

This is but one of many misconceptions associated with electroconvulsive therapy in recent years, Dr. Sackeim told CLINICAL PSYCHIATRY NEWS.

Not long ago, dosing was thought to have no impact on efficacy "The NIH Consensus Conference Report in 1985 said, Always use the lowest amount of energy you can.'" Many people followed this directive well into the 1990s--a directive Dr. Sackeim proved incorrect with his findings in studies published in 1987 (Biol. Psychiatry 22[3]:249-68, 1987 ), 1993 (N. Engl. J. Med. 328[12]:839-46, 1993), and 2000 (Arch. Gen. Psychiatry 57[5]:425-34, 2000).

These studies showed that the response rate for unilateral ECT dosed six times above the seizure threshold was 80%, compared with 17% for patients treated at the seizure threshold. Short- and long-term side effects were significantly reduced, compared with those of bilateral ECT.

"So the dosage effect is critical for the efficacy of unilateral ECT ... and unilateral ECT retains significant cognitive advantages over bilateral ECT," Dr. Sackeim said at the symposium, also sponsored by the University of Texas, Dallas, and the University of New Mexico.

It also was believed, until recently, that doing nothing after ECT would result in a 50% relapse rate within 6 months to a year, while adding a traditional antidepressant would cut the relapse rate to 20%. The studies on which this thinking was based, however, were done at a time when ECT was considered the treatment of choice for major depression, and patients chosen were not terribly medication resistant, which is more likely to produce relapse. …

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