Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study.
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2019-10-12
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OBJECTIVE:There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study. METHODS:Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05. RESULTS:A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest. CONCLUSION:This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.
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Lisanby, Sarah H, Shawn M McClintock, George Alexopoulos, Samuel H Bailine, Elisabeth Bernhardt, Mimi C Briggs, C Munro Cullum, Zhi-De Deng, et al. (2019). Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. 10.1016/j.jagp.2019.10.003 Retrieved from https://hdl.handle.net/10161/19555.
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Richard David Weiner
Research efforts under my direction have been in electroconvulsive therapy (ECT). First, in a study of unilateral versus bilateral ECT in elderly unilateral ECT non-responders, we have shown that switching to bilateral ECT is associated with a more substantial and enduring response. We have also shown that switching to bilateral ECT is, however, associated with an increase in memory impairment compared to continuing unilateral ECT. Other ECT work has focussed on the effects of various types of stimulus dosing paradigms on therapeutic response, memory impairment, and EEG abnormality. We have also demonstrated an ability to separate EEG seizures produced by various kinds of ECT treatment parameters. This work has led to multiple research efforts to more fully develop electroencephalographic models of treatment adequate with ECT.
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