TY - JOUR
T1 - Longitudinal Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Pharmacotherapy in Major Depressive Disorder in Older Adults
T2 - Phase 2 of the PRIDE Study
AU - Prolonging Remission in Depressed Elderly (PRIDE) Work Group
AU - Lisanby, Sarah H.
AU - McClintock, Shawn M.
AU - McCall, William V.
AU - Knapp, Rebecca G.
AU - Cullum, C. Munro
AU - Mueller, Martina
AU - Deng, Zhi De
AU - Teklehaimanot, Abeba A.
AU - Rudorfer, Matthew V.
AU - Bernhardt, Elisabeth
AU - Alexopoulos, George
AU - Bailine, Samuel H.
AU - Briggs, Mimi C.
AU - Geduldig, Emma T.
AU - Greenberg, Robert M.
AU - Husain, Mustafa M.
AU - Kaliora, Styliani
AU - Latoussakis, Vassilios
AU - Liebman, Lauren S.
AU - Petrides, Georgios
AU - Prudic, Joan
AU - Rosenquist, Peter B.
AU - Sampson, Shirlene
AU - Tobias, Kristen G.
AU - Weiner, Richard D.
AU - Young, Robert C.
AU - Kellner, Charles H.
N1 - Funding Information:
George Alexopoulos . Dr. Alexopoulos reports having served in the speakers bureau of Otsuka, Lundbeck, Takeda, Allergan, Sunovion, and Astra Zeneca. Samuel H. Bailine . Dr. Bailine reports no conflicts of interest. Elisabeth Bernhardt . Ms. Bernhardt reports no conflicts of interest. Mimi C. Briggs . Dr. Briggs reports no conflicts of interest. C. Munro Cullum . Dr. Cullum reports no conflicts of interest. Zhi-De Deng . Dr. Deng reports no conflicts of interest. Emma T. Geduldig . Ms. Geduldig reports no conflicts of interest. Robert M. Greenberg . Dr. Greenberg reports no conflicts of interest. Mustafa M. Husain . Dr. Husain reports research support from the National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, Stanley Medical Research Foundation, Neuronetics, Inc., MagStim (equipment only), Brainsway, Inc., NeoSync and consulting income from Cerebain Inc. Speaker bureau for Acadia Pharmaceutical. Consultant to the Neurological Devices Panel of the Medical Devices Advisory Committee, Center for Devices and Radiological Health, Food and Drug Administration (FDA). Editorial Board Member of the Journal of ECT. Styliani Kaliora . Dr. Kaliora reports no conflicts of interest. Charles H. Kellner . Dr. Kellner receives honoraria from UpToDate, Psychiatric Times, and Northwell Health and royalties from Cambridge University Press Rebecca G. Knapp . Dr. Knapp reports no conflicts of interest. Vassilios Latoussakis . Dr. Latoussakis reports no conflicts of interest. Lauren S. Liebman . Ms. Liebman reports no conflicts of interest. Sarah H. Lisanby . . Dr. Lisanby has received grant support from the Brain and Behavior Research Foundation, the Stanley Medical Research Foundation, Neosync, Nexstim, NIH, and Brainsway. This manuscript was prepared while Dr. Sarah H. Lisanby was employed at Duke University. The opinions expressed in this article are the author's own and do not reflect the views of the National Institutes of Health, the Department of Health and Human Services, or the United States government. William V. McCall . Dr. McCall has served as a scientific adviser for Jazz, Sage, and Janssen pharmaceuticals, and he has received research support from the American Foundation for Suicide Prevention, NIMH, PCORI, MECTA Corp, Merck, Vistagen, and Otsuka. He has received royalties from Wolters Kluwer, and honoraria from Anthem, Inc., CME Outfitters, Global Medical Education, and Merck. Shawn M. McClintock . Dr. McClintock reports research support from the National Institutes of Health. He is a consultant to Pearson Assessment. Martina Mueller . Dr. Mueller reports no conflicts of interest. Georgios Petrides . Dr. Petrides has received research support from Amgen, AstraZeneca, Corcept, Eli Lilly, Proteus, St. Jude Medical, and Sunovion, and he has served on an advisory panel for Corcept. Joan Prudic . Dr. Prudic reports no conflicts of interest. Peter B. Rosenquist . Dr. Rosenquist reports no conflicts of interest. Matthew V. Rudorfer . Dr. Rudorfer reports no conflicts of interest. Shirlene Sampson . Dr. Sampson reports no conflicts of interest. Abeba Teklehaimanot . Ms. Teklehaimanot reports no conflicts of interest. Kristen G. Tobias . Dr. Tobias reports no conflicts of interest. Richard D. Weiner . Dr. Weiner reports no conflicts of interest. Robert C. Young . Dr. Young has received research support from NIMH.
Funding Information:
The research is supported by National Institute of Mental Health (NIMH) grants U01 MH055495 , U01 MH081362 , U01 MH086127 , U01 MH086127 , U01 MH086130 , U01 MH08612005 , U01 MH084241 , and U01 MH086122 . Drs. Deng and Lisanby are supported by the NIMH Intramural Research Program.
Publisher Copyright:
© 2021
PY - 2021/5/17
Y1 - 2021/5/17
N2 - OBJECTIVE: There is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study.METHOD: After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test).RESULTS: With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility.CONCLUSION: To our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression.
AB - OBJECTIVE: There is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study.METHOD: After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test).RESULTS: With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility.CONCLUSION: To our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression.
KW - Electroconvulsive therapy
KW - major depression
KW - neurocognitive adverse effects
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U2 - 10.1016/j.jagp.2021.04.006
DO - 10.1016/j.jagp.2021.04.006
M3 - Article
C2 - 34074611
SN - 1064-7481
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
ER -