Electroconvulsive therapy achieved a significantly higher overall remission rate (62.8%) compared to medication (32.1%) in older patients with severe depression, independent of the presence of vascular risk factors.
Observational (n=124)
Yes
Does electroconvulsive therapy improve remission of depressive symptoms compared to medication in older patients with depression and vascular risk factors?
Electroconvulsive therapy is more efficacious than antidepressant medication for severe depression in older adults, and this advantage is not modified by the presence of vascular risk factors.
Absolute Event Rate: 62.8% vs 32.1%
p-value: p=0.001
OBJECTIVE: Research suggests that in depression, vascular burden predicts a lower efficacy for medication (MED) and a more favourable outcome for electroconvulsive therapy (ECT). Therefore, we investigated the influence of the following vascular risk factors (VRF): hypercholesterolemia, hypertension, smoking, diabetes mellitus, cardiovascular disease, and cerebral vascular accident/transient ischemic attack, on remission from major depression after ECT versus MED. METHODS: The study sample consisted of 81 inpatients with a DSM-IV unipolar major depression diagnosis (mean age 72.2 years, SD = 7.6, mean Montgomery-Åsberg Depression Rating Scale score 32.9, SD = 6.2) participating in a randomized controlled trial comparing nortriptyline versus venlafaxine and 43 inpatients (mean age 73.7 years, SD = 7.5, mean Montgomery-Åsberg Depression Rating Scale score 30.6, SD = 7.1) from an randomized controlled trial comparing brief pulse versus ultrabrief pulse ECT. The presence of VRF was established from the medical records. The remission rate of patients with VRF was compared with those of patients without VRF. RESULTS: = 0.119, p = 0.707) in MED patients. Applying different cut-offs for the number of VRFs yielded the same trends. Logistic regression revealed no interaction between VRF and treatment condition. CONCLUSION: The superior efficacy of ECT over pharmacotherapy in major depression in older age was independent of the presence of VRF. Copyright © 2017 John Wiley & Sons, Ltd.
Spaans et al. (2017) conducted an observational in Major depression in older patients (n=124). Electroconvulsive therapy (ECT) vs. Antidepressant medication (nortriptyline or venlafaxine) was evaluated on Remission of depressive symptoms (MADRS score < 10) (p=0.001). Electroconvulsive therapy achieved a significantly higher overall remission rate (62.8%) compared to medication (32.1%) in older patients with severe depression, independent of the presence of vascular risk factors.