Electroconvulsive Therapy (ECT) remains an important treatment for serious depression. Despite being the oldest biological treatment for depression, its use is increasing worldwide, particularly in the geriatric population. Technical improvements have resulted in a more benign side-effect profile; this coupled with its unsurpassed efficacy are responsible for ECT’s important place in modern treatment algorithms. In this symposium we present data from Phase I of the ongoing multisite, NIMH-supported trial comparing continuation ECT versus pharmacotherapy (lithium and nortriptyline). Phase I represents the acute course of ECT given prior to randomization to the 2 treatment arms in Phase II. In the C.O.R.E. study, patients with unipolar major depression, referred for ECT, receive a standardized course of bilateral ECT 3X/wk at 1.5X seizure threshold. A HAMD24 score of ³ 21 is required for study entry and remission criteria include 2 consecutive HAMD24 ratings of £ 10, with ³ 60% reduction from baseline. HAMD24 ratings are performed at baseline and 24 hrs. after each ECT. We present data from the first 444 patients entered into the trial. Patient demographics are as follows: Age (mean ± sd = 55.6±16.8, Gender (%female) = 68.2 (303/444), Psychosis status (% psychotic) = 29.7 (132/444), Race (%white) = 91.7 (407/444) Overall remission rate was 68.5% (304/444). Remission rate in those patients with psychotic depression was 75% (99/132). Patients ³ 65 yrs.of age had a remission rate of 71.3% (112/157). Patients responded very rapidly to ECT. After 6 treatments (2 weeks) 34.9% (155/444) of patients had reached remission criteria. ECT resolved suicidality very rapidly. 81% of patients with high baseline suicide ratings were no longer suicidal after 6 treatments. These data, from one of the largest ECT datasets in the modern era, confirm the high and rapid efficacy of ECT in major depression, particularly in the geriatric population and those with psychotic major depression.
Back to S070 The Efficacy of ECT in Major Depression: Findings from Phase I of the C.O.R.E.* ECT Study
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