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  • Pharmacological strategies in the prevention of relapse after electroconvulsive therapy.

Pharmacological strategies in the prevention of relapse after electroconvulsive therapy.

The journal of ECT (2013-01-11)
Joan Prudic, Roger F Haskett, W Vaughn McCall, Keith Isenberg, Thomas Cooper, Peter B Rosenquist, Benoit H Mulsant, Harold A Sackeim
ABSTRACT

To determine whether starting antidepressant medication at the start of electroconvulsive therapy (ECT) reduces post-ECT relapse and to determine whether continuation pharmacotherapy with nortriptyline (NT) and lithium (Li) differs in efficacy or adverse effects from continuation pharmacotherapy with venlafaxine (VEN) and Li. During an acute ECT phase, 319 patients were randomized to treatment with moderate dosage bilateral ECT or high-dosage right unilateral ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN. Of 181 patients to meet post-ECT remission criteria, 122 (67.4%) participated in a second continuation pharmacotherapy phase. Patients earlier randomized to NT or VEN continued on the antidepressant, whereas patients earlier randomized to placebo were now randomized to NT or VEN. Lithium was added for all patients who were followed until relapse or 6 months. Starting an antidepressant medication at the beginning of the ECT course did not affect the rate or timing of relapse relative to starting pharmacotherapy after ECT completion. The combination of NT and Li did not differ from VEN and Li in any relapse or adverse effect measure. Older age was strongly associated with lower relapse risk, whereas the type of ECT administered in the acute phase and medication resistance were not predictive. Across sites, 50% of the patients relapsed, 33.6% continued in remission 6 months after ECT, and 16.4% dropped out. Starting an antidepressant medication during ECT does not affect relapse, and there are concerns about administering Li during an acute ECT course. Nortriptyline and VEN were equally effective in prolonging remission, although relapse rates after ECT are substantial despite intensive pharmacology. As opposed to the usual abrupt cessation of ECT, the impact of an ECT taper should be evaluated.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Nortriptyline hydrochloride, ≥98% (HPLC), powder
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Sigma-Aldrich
Venlafaxine hydrochloride, ≥98% (HPLC), powder
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$81.70
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50 mg
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Supelco
Venlafaxine hydrochloride solution, 1.0 mg/mL in methanol (as free base), ampule of 1 mL, certified reference material, Cerilliant®
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10 mg
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50 mg
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$329.00
Nortriptyline hydrochloride, European Pharmacopoeia (EP) Reference Standard
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10 mg
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$81.70
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50 mg
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Venlafaxine for system suitability, European Pharmacopoeia (EP) Reference Standard
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10 mg
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$81.70
$71.08
50 mg
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$329.00
Venlafaxine hydrochloride, European Pharmacopoeia (EP) Reference Standard
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10 mg
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$81.70
$71.08
50 mg
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$329.00
Sigma-Aldrich
Lithium carbonate, 99.997% trace metals basis
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10 mg
In Stock
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$81.70
$71.08
50 mg
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$329.00
Supelco
Nortriptyline hydrochloride solution, 1.0 mg/mL in methanol (as free base), ampule of 1 mL, certified reference material, Cerilliant®
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SKUPack SizeAvailabilityPriceQuantity
10 mg
In Stock
Details...
$81.70
$71.08
50 mg
In Stock
Details...
$329.00
Sigma-Aldrich
Lithium carbonate, 99.999% trace metals basis
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SKUPack SizeAvailabilityPriceQuantity
10 mg
In Stock
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$81.70
$71.08
50 mg
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$329.00
Sigma-Aldrich
Lithium carbonate, puriss. p.a., ACS reagent, reagent (for microscopy), ≥99.0% (T)
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10 mg
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$81.70
$71.08
50 mg
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$329.00
Sigma-Aldrich
Lithium carbonate, ACS reagent, ≥99.0%
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SKUPack SizeAvailabilityPriceQuantity
10 mg
In Stock
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$81.70
$71.08
50 mg
In Stock
Details...
$329.00