Data grow in support of ECT for depression
EXPERT ANALYSIS FROM the ECNP Congress
At 6 months, nearly a third of remitters in each group had relapsed with a 10-point or higher increase from their HAM-D taken at the end of their treatment.
The high-dose patients also experienced less impairment to their autobiographical memory (details they told the clinician before receiving ECT) directly after treatment and at 6-month follow-up. The low-dose patients overall recalled about 60% of their autobiographical memory, compared with the high dose group’s 70%. However, Dr. McLoughlin noted that this is normal in the general population, “but it’s probably a bit worse in depressed patients.”
An as yet unpublished meta-analysis Dr. McLoughlin and his colleagues conducted of the six previous trials comparing the efficacy of these two forms of ECT also found no significant difference between the two regarding response or remission, and that higher doses of ECT offered better reorientation times, and better retrograde autobiographical memory, with no differences in global cognition, complex figure tests, or verbal learning.
While cognitive data from the PRIDE phase I and efficacy data from the study’s phase II are forthcoming, according to Dr. Kellner, he agreed with Dr. McLoughlin that overall, bilateral treatments were better, although the unilateral treatments approach the same efficacy levels. Ultimately, however, group data are irrelevant if they fail to jibe with what is happening in front of a clinician treating a patient.
“For an individual patient who doesn’t respond to right unilateral ECT, it’s imperative they be switched over to a different form of ECT,” said Dr. Kellner, since many right unilateral nonresponders will do well with bilateral ECT. “Particularly if patients are urgently ill, one should consider using bilateral ECT from the outset. I still believe that is a true clinical dictum.”
The lineup of international ECT experts drew roughly 200 audience members, the largest such ECT audiences Dr. Kellner and Dr. Sienaert said they’d ever seen.
“The biggest problem is ECT remains stigmatized,” Dr. Kellner said. “It needs to be said at any ECT gathering.”
Dr. Kellner is a consultant to Luitpold Pharmaceuticals. Dr. Sienaert noted he had received travel expenses in the past year from MECTA, and Dr. McLoughlin had no relevant disclosures.
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