4.5 Article

Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study

Journal

AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY
Volume 28, Issue 3, Pages 304-316

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jagp.2019.10.003

Keywords

Major depressive disorder; electroconvulsive therapy; geriatric; neuropsychology; memory

Funding

  1. National Institute of Mental Health (NIMH) [U01 MH055495, U01 MH081362, U01 MH086127, U01 MH086130, U01 MH08612005, U01 MH084241, U01 MH086122]
  2. NIMH Intramural Research Program
  3. NATIONAL INSTITUTE OF MENTAL HEALTH [ZIAMH002955] Funding Source: NIH RePORTER

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Objective: There 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 neuro-cognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study. Methods: Elderly 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. Results: A 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. Conclusion: This 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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