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Treatment refractory depression in the elderly: The role of maintenance electroconvulsive therapy

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Current Psychosis & Therapeutics Reports

Abstract

Treatment refractory depression is a major concern for primary care and mental health specialists alike. This is particularly so in the elderly, who are most vulnerable to the effects of depression on physical and psychosocial functioning, as well as suicide. Electroconvulsive therapy (ECT) is the most effective treatment for depression refractory to medication. Patients who are refractory to medication and subsequently respond to ECT are at high risk of relapse following ECT, and as such maintenance treatment has particular salience in the medication refractory population. The use of ECT as maintenance treatment will be reviewed in this article, with a particular focus on the use of this modality in elderly patients who are refractory to medications.

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References and Recommended Reading

  1. Mitchell AJ, Subramaniam H:Prognosis of depression in old age compared to middle age: a systematic review of comparative studies.Am J Psychiatry 2005,162:1588–1601.

    Article  PubMed  Google Scholar 

  2. Murphy E:The prognosis of depression in old age.Br J Psychiatry 1983,142:111–119.

    PubMed  CAS  Google Scholar 

  3. Stoudemire A, Hill CD, Morris R, et al.:Cognitive outcome following tricyclic and electroconvulsive treatment of major depression in the elderly.Am J Psychiatry 1991,148:1336–1340.

    PubMed  CAS  Google Scholar 

  4. Guscott R, Grof P:The clinical meaning of refractory depression: a review for the clinician.Am J Psychiatry 1991,148:695–704.

    PubMed  CAS  Google Scholar 

  5. Bauer M, Whybrow PC, Angst J, et al.:World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 2: maintenance treatment of major depressive disorder and treatment of chronic depressive disorders and subthreshold depressions.World J Biol Psychiatry 2002,3:69–86.

    PubMed  Google Scholar 

  6. Bauer M, Whybrow PC, Angst J, et al.:World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: acute and continuation treatment of major depressive disorder.World J Biol Psychiatry 2002,3:5–43.

    Article  PubMed  Google Scholar 

  7. Andrade C, Kurinji S:Continuation and maintenance ECT: a review of recent research.J ECT 2002,18:149–158.

    Article  PubMed  Google Scholar 

  8. Paykel ES, Ramana R, Cooper Z, et al.:Residual symptoms after partial remission: an important outcome in depression.Psychol Med 1995,25:1171–1180.

    Article  PubMed  CAS  Google Scholar 

  9. Shorter E:A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons, Inc.; 1997.

    Google Scholar 

  10. Fagiolini A, Kupfer DJ:Is treatment-resistant depression a unique subtype of depression? Biol Psychiatry 2003,53:640–648.

    Article  PubMed  Google Scholar 

  11. Thase ME, Rush AJ:Treatment-resistant depression. InPsychopharmacology: The Fourth Generation of Progress. Edited by Bloom FE, Kupfer DJ. New York: Raven Press; 1995:1081–1098.

    Google Scholar 

  12. Nierenberg AA, Amsterdam JD:Treatment-resistant depression: definition and treatment approaches.J Clin Psychiatry 1990,51 (Suppl):39–50.

    PubMed  Google Scholar 

  13. Alexopoulos GS, Vrontou C, Kakuma T, et al.:Disability in geriatric depression.A J Psychiatry 1996,153:877–885.

    CAS  Google Scholar 

  14. Keller MB, Shapiro RW, Lavori PW, Wolfe N:Recovery in major depressive disorder: analysis with the life table and regression models.Arch Gen Psychiatry 1982,39:905–910.

    PubMed  CAS  Google Scholar 

  15. Keller MB, Lavori PW, Lewis CE, Klerman GL:Predictors of relapse in major depressive disorder.JAMA 1983,250:3299–3304.

    Article  PubMed  CAS  Google Scholar 

  16. Bech P:Acute therapy of depression.J Clin Psychiatry 1993,54(Suppl):18–28.

    PubMed  Google Scholar 

  17. Baldwin RC, Simpson S:Treatment resistant depression in the elderly: a review of its conceptualisation, management and relationship to organic brain disease.J Affect Disord 1997,46:163–173.

    Article  PubMed  CAS  Google Scholar 

  18. Copeland JR, Davidson IA, Dewey ME, et al.:Alzheimer’s disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool.Br J Psychiatry 1992,161:230–239.

    PubMed  CAS  Google Scholar 

  19. Beekman AT, Deeg DJ, Smit JH, van Tilburg W:Predicting the course of depression in the older population: results from a community-based study in The Netherlands.J Affect Disord 1995,34:41–49.

    Article  PubMed  CAS  Google Scholar 

  20. Reynolds CF 3rd, Frank E, Perel JM, et al.:Treatment of consecutive episodes of major depression in the elderly.Am J Psychiatry 1994,151:1740–1743.

    PubMed  Google Scholar 

  21. O’Connor MK, Knapp R, Husain M, et al.:The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report.Am J Geriatr Psychiatry 2001,9:382–390.

    Article  PubMed  CAS  Google Scholar 

  22. Group UER:Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis.Lancet 2033,361:799–808.

    Google Scholar 

  23. van der Wurff FB, Stek ML, Hoogendijk WJ, Beekman AT:The efficacy and safety of ECT in depressed older adults: a literature review.Int J Geriatr Psychiatry 2003,18:894–904.

    Article  PubMed  Google Scholar 

  24. Prudic J, Sackeim HA, Devanand DP:Medication resistance and clinical response to electroconvulsive therapy.Psychiatry Res 1990,31:287–296.

    Article  PubMed  CAS  Google Scholar 

  25. Prudic J, Haskett RF, Mulsant B, et al.:Resistance to antidepressant medications and short-term clinical response to ECT.Am J Psychiatry 1996,153:985–992.

    PubMed  CAS  Google Scholar 

  26. Weiner RD, Coffey CE, Fochtmann LJ, et al.:The Practice of Electroconvulsive Therapy, Recommendations for Treatment, Training, and Privileging, a Task Force Report of The American Psychiatric Association, edn 2. Washington, D.C.: American Psychiatric Association; 2001.

    Google Scholar 

  27. Moore NP:The maintenance treatment of chronic psychotics by electrically induced convulsions.J Ment Sci 1943,89:257–269.

    Google Scholar 

  28. Swoboda E, Conca A, Konig P, et al.:Maintenance electroconvulsive therapy in affective and schizoaffective disorder.Neuropsychobiology 2001,43:23–28.

    Article  PubMed  CAS  Google Scholar 

  29. Fink M:Impact of the antipsychiatry movement on the revival of electroconvulsive therapy in the United States.Psychiatr Clin North Am 1991,14:793–801.

    PubMed  CAS  Google Scholar 

  30. Fink M, Abrams R, Bailine S, Jaffe R:Ambulatory electroconvulsive therapy: report of a task force of the association for convulsive therapy. Association for Convulsive Therapy.Convuls Ther 1996,12:42–55.

    PubMed  CAS  Google Scholar 

  31. Seager CP, Bird RL:Imipramine with electrical treatment in depression—a controlled trial.J Ment Sci 1962,108:704–707.

    PubMed  CAS  Google Scholar 

  32. O’Leary DA, Lee AS:Seven year prognosis in depression. Mortality and readmission risk in the Nottingham ECT cohort.Br J Psychiatry 1996,169:423–429.

    PubMed  CAS  Google Scholar 

  33. Sackeim HA, Prudic J, Devanand DP, et al.:The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression.J Clin Psychopharmacol 1990,10:96–104.

    Article  PubMed  CAS  Google Scholar 

  34. Sackeim HA, Haskett RF, Mulsant BH, et al.:Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial.JAMA 2001,285:1299–1307.

    Article  PubMed  CAS  Google Scholar 

  35. Procopio M:NICE guidelines and maintenance ECT.Br J Psychiatry 2003,183:263.

    Article  PubMed  CAS  Google Scholar 

  36. Gagne GG Jr, Furman MJ, Carpenter LL, Price LH:Efficacy of continuation ECT and antidepressant drugs compared to long-term antidepressants alone in depressed patients.Am J Psychiatry 2000,157:1960–1965.

    Article  PubMed  Google Scholar 

  37. McDonald WM, Phillips VL, Figiel GS, et al.:Cost-effective maintenance treatment of resistant geriatric depression.Psychiatr Ann 1998,28:47–52.

    Google Scholar 

  38. Kramer BA:A naturalistic review of maintenance ECT at a university setting.J ECT 1999,15:262–269.

    PubMed  CAS  Google Scholar 

  39. Schwarz T, Loewenstein J, Isenberg KE:Maintenance ECT: indications and outcome.Convuls Ther 1995,11:14–23.

    PubMed  CAS  Google Scholar 

  40. Vanelle JM, Loo H, Galinowski A, et al.:Maintenance ECT in intractable manic-depressive disorders.Convuls Ther 1994,10:195–205.

    PubMed  CAS  Google Scholar 

  41. Russell JC, Rasmussen KG, O’Connor MK, et al.:Long-term maintenance ECT: a retrospective review of efficacy and cognitive outcome.J ECT 2003,19:4–9.

    Article  PubMed  Google Scholar 

  42. Grunhaus L, Pande AC, Haskett RF:Full and abbreviated courses of maintenance electroconvulsive therapy.Convuls Ther 1990,6:130–138.

    PubMed  Google Scholar 

  43. Dubin WR, Jaffe R, Roemer R, et al.:The efficacy and safety of maintenance ECT in geriatric patients.J Am Geriatr Soc 1992,40:706–709.

    PubMed  CAS  Google Scholar 

  44. Thienhaus OJ, Margletta S, Bennett JA:A study of the clinical efficacy of maintenance ECT.J Clin Psychiatry 1990,51:141–144.

    PubMed  CAS  Google Scholar 

  45. McDonald WM, Thompson TR, Okun LB, et al.:Post-ECT continuation and maintenance [abstract].J ECT 2005,21:54–55.

    Article  Google Scholar 

  46. Cattan RA, Barry PP, Mead G, et al.:Electroconvulsive therapy in octogenarians.J Am Geriatr Soc 1990,38:753–758.

    PubMed  CAS  Google Scholar 

  47. Kupfer DJ, Frank E, Perel JM, et al.:Five-year outcome for maintenance therapies in recurrent depression.Arch Gen Psychiatry 1992,49:769–773.

    PubMed  CAS  Google Scholar 

  48. Wijkstra J, Nolen WA:Successful maintenance electroconvulsive therapy for more than seven years.J ECT 2005,21:171–173.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1841 Clifton Road, 3rd Floor WWHSC, 30329, Atlanta, GA, USA

    Bruce Rudisch MD

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  1. Bruce Rudisch MD
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  2. William M. McDonald MD
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Correspondence to Bruce Rudisch MD.

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Rudisch, B., McDonald, W.M. Treatment refractory depression in the elderly: The role of maintenance electroconvulsive therapy. Current Psychosis & Therapeutics Reports 4, 79–83 (2006). https://doi.org/10.1007/BF02629327

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