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Can ECT be extended to patients with moderate-severity MDD?

Key clinical point: Electroconvulsive therapy (ECT) in combination with venlafaxine appears to be an effective treatment for moderate-severity major depressive disorder (MDD).

Major finding: ECT combined with venlafaxine was effective in both severe MDD and moderate-severity MDD; mean changes in 6-item Hamilton Depression Rating Scale scores were −8.2 and −5.9, respectively; P less than .001. 63% of severe MDD patients vs 75% of moderate-severity MDD patients achieved remission, with no significant difference between the 2 groups (P = .27).

Study details: Analysis of 240 patients with MDD who received right unilateral ultrabrief pulse ECT combined with venlafaxine from the Prolonging Remission in Depressed Elderly study.

Disclosures: The study was funded by the National Institute of Mental Health. CH Kellner, SM McClintock, MF Husain, G Petrides, WV McCall, and SH Lisanby received grants from various sources. S Østergaard and MS Speed reported no conflicts of interest.

Commentary

“Electroconvulsive Therapy (ECT) has been used for decades and is considered one of the most effective treatments in the acute phase at lowering major depressive disorders symptoms to the point of remission. In clinical practice it is often held for use later in treatment after depression has become resistant or even refractory to several medications and psychotherapy. Like most diseases and disorders, the earlier a clinician intervenes, and the faster symptoms are remitted, then a better outcome and prognosis is usually afforded. This study suggests that with aggressive SNRI antidepressant therapy, that moderate depressives can respond and remit with an ECT combination protocol. As some patients cannot afford psychotherapy or tolerate aggressive polypharmacy, use of ECT may be considered in partial responders to antidepressant therapy who are more moderately depressed. ECT could be considered early in treatment algorithms.”

Thomas L. Schwartz, MD
Senior Associate Dean of Education, Interim Chair/Professor of Psychiatry
SUNY Upstate Medical University

Citation:

Østergaard SD et al. J Affect Disord. 2020 Sep 1. doi: 10.1016/j.jad.2020.05.039.