Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study |
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| Affiliation: | 1. Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine (SHL – Now at the National Institute of Mental Health; SMM, MMH), Durham, NC;2. Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health (SHL, Z-DD), Bethesda, Maryland;3. Department of Psychiatry, UT Southwestern Medical Center (SMM, CMC, MMH), Dallas, TX;4. Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center (GA, VL, RCY), White Plains, NY;5. Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System (SHB, SK, GP), New York, NY;6. Department of Nursing, Duke University School of Medicine (EB), Durham, NC;7. Department of Psychiatry, Icahn School of Medicine at Mount Sinai (MCB, ETG, LSL, CHK), New York, NY;8. NYU Langone (RMG), New York, NY;9. Department of Public Health Sciences, College of Medicine, Medical University of South Carolina (MD, RGK, MM, AAT), Charleston, SC;10. Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University (WVM, PBR), Augusta, GA;11. Department of Psychiatry, Columbia University/New York State Psychiatric Institute (JP), New York, NY;12. Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health (MVR), Bethesda, MD;13. Department of Psychiatry and Psychology, Mayo Clinic (SS), Rochester, MN;14. VA New Jersey Health Care System (KGT), East Orange, NJ;15. Department of Psychiatry and Behavioral Sciences, Duke University (RDW), Durham, NC;1. Department of Psychiatry (CA, HJA, MAB, HTK), University of Pittsburgh, Pittsburgh, PA;2. Department of Psychiatry (OA), University of Illinois, Chicago, IL;3. Department of Bioengineering (HJA), University of Pittsburgh, Pittsburgh, PA;4. Department of Psychiatry and Behavioral Sciences (KA, WDT), The Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN;5. Departments of Computer Science, Electrical Engineering, and Biomedical Engineering (BAL), Vanderbilt University, TN;6. Department of Radiology and Radiological Sciences (BAL), Vanderbilt University Medical Center, Nashville, TN;7. Department of Biostatistics (RK), University of Pittsburgh, Pittsburgh, PA;8. Department of Veterans Affairs Medical Center (WDT), Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN;1. Department of Psychiatry and Psychology, (MIL) Mayo Clinic, Rochester, MN;2. Neurotherapeutics Program (SS), McLean Hospital, Boston, MA;3. Harvard Medical School (SS, BPF), Boston, MA;4. Division of Geriatric Psychiatry (HH, BPF), McLean Hospital, Boston, MA;5. Department of Psychiatry and Behavioral Sciences (APH), Emory University, Atlanta, GA;6. Pine Rest Christian Mental Health Center (LN), Grand Rapids, MI;7. Zucker Hillside Hospital, Northwell Health System (SNS, GP), Glen Oaks, NY;8. Zucker School of Medicine at Hofstra/Northwell (SNS, GP), Hempstead, NY;9. College of Nursing & Department of Public Health Sciences (MM), Medical University of South Carolina, Charleston, SC;1. Menninger Department of Psychiatry and Behavioral Sciences (KCJ, MEK), Baylor College of Medicine, Houston;2. the Center of Excellence in Health Equity, Training and Research (KCJ, JLS, DD, SMR, THQ, HMS), Baylor College of Medicine, Houston;3. the Houston VA Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety (MEK), Michael E. DeBakey VA Medical Center, Houston;4. the VA South Central Mental Illness Research, Education and Clinical Center (MEK);1. Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands;2. EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands;3. Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands;4. Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium;5. Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium;6. Department of Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium;7. Research Group of Quantitative Psychology and Individual Differences, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium;8. Translational MRI, Department of Imaging and Pathology, KU Leuven & Radiology, University Hospitals Leuven, Leuven, Belgium;1. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada;2. Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada;3. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada |
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| Abstract: | ObjectiveThere is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study.MethodsElderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05.ResultsA total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest.ConclusionThis is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable. |
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