NDLI: Continuation Pharmacotherapy in the Prevention of Relapse Following Electroconvulsive Therapy: A Randomized Controlled Trial

Content Provider	JAMA Network
Author	Sackeim, Harold A. Haskett, Roger F. Mulsant, Benoit H. Thase, Michael E. Mann, J. John Pettinati, Helen M. Greenberg, Robert M. Crowe, Raymond R. Cooper, Thomas B. Prudic, Joan
Copyright Year	2001
Abstract	Context: Electroconvulsive therapy ( ECT) is highly effective for treatment of major depression, but naturalistic studies show a high rate of relapse after discontinuation of ECT. Objective: To determine the efficacy of continuation pharmacotherapy with nortriptyline hydrochloride or combination nortriptyline and lithium carbonate in preventing post- ECT relapse. Design: Randomized, double-blind, placebo-controlled trial conducted from 1993 to 1998, stratified by medication resistance or presence of psychotic depression in the index episode. Setting: Two university-based hospitals and 1 private psychiatric hospital. Patients: Of 290 patients with unipolar major depression recruited through clinical referral who completed an open ECT treatment phase, 159 patients met remitter criteria; 84 remitting patients were eligible and agreed to participate in the continuation study. Interventions: Patients were randomly assigned to receive continuation treatment for 24 weeks with placebo (n = 29), nortriptyline (target steady-state level, 75-125 ng/m: L) (n = 27), or combination nortriptyline and lithium (target steady-state level, 0.5-0.9 m: Eq/ L) (n = 28). Main Outcome Measure: Relapse of major depressive episode, compared among the 3 continuation groups. Results: Nortriptyline-lithium combination therapy had a marked advantage in time to relapse, superior to both placebo and nortriptyline alone. Over the 24-week trial, the relapse rate for placebo was 84% (95% confidence interval [ CI], 70%-99%); for nortriptyline, 60% (95% CI, 41%-79%); and for nortriptyline-lithium, 39% (95% CI, 19%-59%). All but 1 instance of relapse with nortriptyline-lithium occurred within 5 weeks of ECT termination, while relapse continued throughout treatment with placebo or nortriptyline alone. Medication-resistant patients, female patients, and those with more severe depressive symptoms following ECT had more rapid relapse. Conclusions: Our study indicates that without active treatment, virtually all remitted patients relapse within 6 months of stopping ECT. Monotherapy with nortriptyline has limited efficacy. The combination of nortriptyline and lithium is more effective, but the relapse rate is still high, particularly during the first month of continuation therapy.
Ending Page	1307
Starting Page	1299
Page Count	9
File Format	PDF HTM / HTML
ISSN	00987484
DOI	10.1001/jama.285.10.1299
Issue Number	10
Journal	JAMA
Volume Number	285
Language	English
Publisher	American Medical Association
Publisher Date	2001-03-14
Access Restriction	Open
Subject Keyword	electroconvulsive therapy lithium nortriptyline relapse prevention lithium carbonate severe major depression with psychotic features pharmacotherapy major depressive disorder depressive disorders combined modality therapy
Content Type	Text
Resource Type	Article
Subject	Medicine

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression: A Multisite Study From the Consortium for Research in Electroconvulsive Therapy (CORE)

Nortriptyline and Interpersonal Psychotherapy as Maintenance Therapies for Recurrent Major Depression: A Randomized Controlled Trial in Patients Older Than 59 Years

A Double-blind Randomized Controlled Trial of Olanzapine Plus Sertraline vs Olanzapine Plus Placebo for Psychotic Depression: The Study of Pharmacotherapy of Psychotic Depression (STOP-PD)

Relapse following electroconvulsive therapy.

Cognitive remediation following electroconvulsive therapy in patients with treatment resistant depression: randomized controlled trial of an intervention for relapse prevention – study protocol

Sustaining remission of psychotic depression: rationale, design and methodology of STOP-PD ΙΙ

Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression

Improved Safety of Hybrid Electroconvulsive Therapy Compared With Standard Electroconvulsive Therapy in Patients With Major Depressive Disorder: A Randomized, Double-Blind, Parallel-Group Pilot Trial

Sequential treatment with fluoxetine and relapse--prevention CBT to improve outcomes in pediatric depression.

Continuation Pharmacotherapy in the Prevention of Relapse Following Electroconvulsive Therapy: A Randomized Controlled Trial

Similar Documents

Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression: A Multisite Study From the Consortium for Research in Electroconvulsive Therapy (CORE)

Nortriptyline and Interpersonal Psychotherapy as Maintenance Therapies for Recurrent Major Depression: A Randomized Controlled Trial in Patients Older Than 59 Years

A Double-blind Randomized Controlled Trial of Olanzapine Plus Sertraline vs Olanzapine Plus Placebo for Psychotic Depression: The Study of Pharmacotherapy of Psychotic Depression (STOP-PD)

Relapse following electroconvulsive therapy.

Cognitive remediation following electroconvulsive therapy in patients with treatment resistant depression: randomized controlled trial of an intervention for relapse prevention – study protocol

Sustaining remission of psychotic depression: rationale, design and methodology of STOP-PD ΙΙ

Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression

Improved Safety of Hybrid Electroconvulsive Therapy Compared With Standard Electroconvulsive Therapy in Patients With Major Depressive Disorder: A Randomized, Double-Blind, Parallel-Group Pilot Trial

Sequential treatment with fluoxetine and relapse--prevention CBT to improve outcomes in pediatric depression.

Continuation Pharmacotherapy in the Prevention of Relapse Following Electroconvulsive Therapy: A Randomized Controlled Trial