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Maria Speed

Electroconvulsive therapy (ECT) for moderate-severity major depression among the elderly: Data from the pride study

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  • Søren D. Østergaard
  • Maria S. Speed
  • Charles H. Kellner, Icahn School of Medicine at Mount Sinai, Medical University of South Carolina
  • ,
  • Martina Mueller, Medical University of South Carolina
  • ,
  • Shawn M. McClintock, University of Texas Southwestern Medical Center, Duke University
  • ,
  • Mustafa M. Husain, University of Texas Southwestern Medical Center, Duke University
  • ,
  • Georgios Petrides, Zucker Hillside Hospital, Hofstra University
  • ,
  • William V. McCall, Augusta University
  • ,
  • Sarah H. Lisanby, National Institutes of Health
  • ,
  • for the CORE/PRIDE workgroup

Background: Electroconvulsive therapy (ECT) is usually reserved for treatment of severe major depressive disorder (MDD), but may be equally effective in the treatment of moderate-severity MDD. This possibility, however, has only been studied to a very limited extent. We therefore investigated the efficacy of ECT after stratifying patients into severe MDD and moderate-severity MDD. Methods: We used data from the Prolonging Remission in Depressed Elderly (PRIDE) study, in which 240 patients (≥60 years) with MDD were treated with right unilateral ultrabrief pulse ECT, combined with venlafaxine. We used the six-item core depression subscale (HAM-D6) of the Hamilton Depression Rating Scale to define depression severity. Participants with baseline total scores ≥12 on the HAM-D6 were considered to have severe MDD, while those with HAM-D6 total scores <12 were considered to have moderate-severity MDD. Results: Among the participants with severe MDD and moderate-severity MDD, the mean change in the HAM-D6 total score from baseline to endpoint was -8.2 (95% confidence interval (95%CI) = -7.5; -9.0, paired t-test: p < 0.001) and -5.9 (95%CI = -5.1; -6.6, paired t-test: p < 0.001), respectively. A total of 63% of those with severe MDD and 75% of those with moderate-severity MDD achieved remission (HAM-D6 total score ≤4) (Pearson's 2-sample chi-squared test of difference between groups: p = 0.27). Limitations: The PRIDE study was not designed to address this research question. Conclusions: ECT combined with venlafaxine appears to be an effective treatment for moderate-severity MDD. It may be appropriate to expand the indications for ECT to include patients with moderate-severity MDD.

Original languageEnglish
JournalJournal of Affective Disorders
Pages (from-to)1134-1141
Number of pages8
Publication statusPublished - 1 Sept 2020

    Research areas

  • ASSOCIATION, HAMILTON DEPRESSION, METAANALYSIS, REMISSION RATES, SCALE, VALIDITY, Humans, Depression, Treatment Outcome, Depressive Disorder, Major/therapy, Venlafaxine Hydrochloride/therapeutic use, Aged, Electroconvulsive Therapy

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