Effects of continuation electroconvulsive therapy on quality of life in elderly depressed patients: A randomized clinical trial

We examined whether electroconvulsive therapy (ECT) plus medications (STABLE + PHARM group) had superior HRQOL compared with medications alone (PHARM group) as continuation strategy after successful acute right unilateral ECT for major depressive disorder (MDD). We hypothesized that scores from the Medical Outcomes Study Short Form-36 (SF-36) would be higher during continuation treatment in the STABLE + PHARM group versus the PHARM group. The overall study design was called Prolonging Remission in Depressed Elderly (PRIDE). Remitters to the acute course of ECT were re-consented to enter a 6 month RCT of STABLE + PHARM versus PHARM. Measures of depressive symptoms and cognitive function were completed by blind raters; SF-36 measurements were patient self-report every 4 weeks. Participants were 120 patients > 60 years old. Patients with dementia, schizophrenia, bipolar disorder, or substance abuse were excluded. The PHARM group received venlafaxine and lithium. The STABLE + PHARM received the same medications, plus 4 weekly outpatient ECT sessions, with additional ECT session as needed. Participants were mostly female (61.7%) with a mean age of 70.5 +/- 7.2 years. STABLE + PHARM patients received 4.5 +/- 2.5 ECT sessions during Phase 2. STABLE + PHARM group had 7 point advantage (3.5-10.4, 95% CI) for Physical Component Score of SF-36 (P < 0.0001), and 8.2 point advantage (4.2-12.2, 95% CI) for Mental Component Score (P < 0.0001). Additional ECT resulted in overall net health benefit. Consideration should be given to administration of additional ECT to prevent relapse during the continuation phase of treatment of MDD. Clinical Trials.gov: NCT01028508