Longitudinal Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Pharmacotherapy in Major Depressive Disorder in Older Adults: Phase 2 of the PRIDE Study |
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| Institution: | 1. Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program (SHL, ZDD), National Institute of Mental Health, National Institutes of Health, Bethesda, MD;2. Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences (SHL, EB, RDW), Duke University School of Medicine, Durham, NC;3. Division of Psychology, Department of Psychiatry (SMM, CMC, MMH), UT Southwestern Medical Center, Dallas, TX;4. Department of Psychiatry and Health Behavior (WVM, PBR), Medical College of Georgia, Augusta University, Augusta, GA;5. Medical University of South Carolina (RGK, MM, AAT), Charleston, SC;6. Division of Services and Intervention Research (MVR), National Institute of Mental Health, National Institutes of Health, Bethesda, MD;7. Department of Psychiatry and Behavioral Sciences (GA, VL, RCY), New York Presbyterian/Weill Cornell Medical Center, White Plains, NY;8. Department of Psychiatry (SHB, SB, GP), Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY;9. Department of Psychiatry (MCB, ETG, LSL, CHK), Icahn School of Medicine at Mount Sinai, New York, NY;10. NYU Langone (RMG), New York, NY;11. Department of Psychiatry (JP), Columbia University/New York State Psychiatric Institute, New York, NY;12. Department of Psychiatry and Psychology (SS), Mayo Clinic, Rochester, MN;13. VA New Jersey Health Care System (KGT), East Orange, NJ;1. Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea;2. Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea;3. Department of Radiology, Pusan National University School of Medicine, Busan, Republic of Korea;4. Department of Nuclear Medicine, Pusan National University School of Medicine, Busan, Republic of Korea;5. Department of Pathology, Pusan National University School of Medicine, Busan, Republic of Korea;6. Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea;1. Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong;2. Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK;1. Yale School of Medicine, New Haven, CT;2. VA Connecticut Healthcare System, West Haven, CT;3. Johns Hopkins University School of Medicine, Baltimore, MD;4. Middlesex Health, Middletown, CT |
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| Abstract: | ObjectiveThere is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study.MethodAfter achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test).ResultsWith the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility.ConclusionTo our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression. |
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