Ultrabrief ECT May Ease Depression in the Elderly

Katharine Gammon

March 20, 2013

LOS ANGELES — Right unilateral ultrabrief pulses of electroconvulsive therapy (ECT) may be effective in elderly patients with major depression, new research suggests.

The first phase of the Prolonging Remission in Depressed Elderly (PRIDE) study showed that of 141 depressed patients, nearly 63% remitted after 12 ECT treatments.

The open-label study, which was not randomized, will continue and will compare the efficacy of antidepressant medication with that of ECT. The investigators are currently enrolling patients in the study and have a target of 250 to 300 participants.

Remitters will be randomly assigned to receive medication or ECT to determine which method works better to treat depression in geriatric patients.

"We're trying to figure out how to best reduce the problem of relapse after successful ECT," said study investigator W. Vaughn McCall, MD, chair of the Medical College of Georgia Department of Psychiatry and Health Behavior at Georgia Regents University in Augusta.

"Most patients can be left in a state of wellness for depression with minimal side effects, but more than half of the patients relapse — like how if you stop insulin, diabetes will come back. ECT keeps illness at bay, but as soon as you retract treatment, illness can return."

Retaining Memory

The researchers chose to use ultrabrief ECT — which lasts just a quarter of a millisecond vs standard pulse, which lasts 1 millisecond — because it preserves memory and has fewer side effects.

"Memory loss is always a concern, but especially with the elderly who might already have problems with memory," said Dr. McCall. "So anything we can do to reduce it, we like to do."

The study included 141 patients, who were all at least 60 years old (mean age, 69.9), between February 2010 and August 2012. Throughout the study, patients' depressive symptoms are indexed by the 24-item Hamilton Rating Scale for Depression (HRSD-24).

Sixty-three percent of patients remitted (defined as 2 successive HRSD-24 scores < 10); 10% were nonremitters (defined as those who did not meet remission criteria within < 12 treatments), and 27% dropped out (< 12 treatments were administered).

The mean baseline HRSD-24 score was approximately 30.9 at baseline and 11.8 by the end of the first phase of the study. The final average HRSD-24 score for remitters was 6.09 vs 19.21 for nonremitters and 22.6 for dropouts.

Dr. McCall said he continues to wonder whether ultrabrief ECT may take a few more sessions to boost remission rates.

"We typically want to see remission rates of 80% or more, and one of the possible explanations is that ultrabrief ECT, while sparing memory, may be a little bit slower. It's just a guess, but it may take 2 to 3 extra sessions to get patients into remission."

Next Steps

Harold Sackeim, PhD, professor of psychiatry and radiology at Columbia University in New York City and chief of biological psychiatry at the New York State Psychiatric Institute, who was not involved in the study, described the results as "impressive."

"I think the message is encouraging about ultrabrief ECT — especially to see these results in a large, multi-institution sample," Dr. Sackeim told Medscape Medical News.

Dr. Sackeim and Dr. McCall report no relevant financial relationships.

American Association for Geriatric Psychiatry (AAGP) 2013 Annual Meeting. Abstract NR 07. Presented March 15, 2013.