Right unilateral versus bilateral formula‐based electroconvulsive therapy in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial

BackgroundSevere depression can be a life-threatening disorder, especially in elderly patients. A fast-acting treatment is crucial for this group. Electroconvulsive therapy (ECT) may work faster than medication.AimsTo compare the speed of remission using ECT v. medication in elderly in-patients.MethodThe speed of remission in in-patients with a DSM-IV diagnosis of major depression (baseline MADRS score $20) was compared between 47 participants (mean age 74.0 years, s.d. = 7.4) from an ECT randomised controlled trial (RCT) and 81 participants (mean age 72.2 years, s.d. = 7.6) from a medication RCT (nortriptyline v. venlafaxine).ResultsMean time to remission was 3.1 weeks (s.d. = 1.1) for the ECT group and 4.0 weeks (s.d. = 1.0) for the medication group; the adjusted hazard ratio for remission within 5 weeks (ECT v. medication) was 3.4 (95% CI 1.9–6.2).ConclusionsConsidering the substantially higher speed of remission, ECT deserves a more prominent position in the treatment of elderly patients with severe depression.

Download Full-text

Speed of recovery from disorientation may predict the treatment outcome of electroconvulsive therapy (ECT) in elderly patients with major depression

Journal of Affective Disorders ◽

10.1016/j.jad.2015.10.013 ◽

2016 ◽

Vol 190 ◽

pp. 178-186 ◽

Cited By ~ 2

Author(s):

Tor Magne Bjølseth ◽

Knut Engedal ◽

Jūratė Šaltytė Benth ◽

Per Bergsholm ◽

Gro Strømnes Dybedal ◽

...

Keyword(s):

Treatment Outcome ◽

Major Depression ◽

Elderly Patients ◽

Electroconvulsive Therapy

Download Full-text

Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines-A pragmatic open-label cluster-randomized controlled trial in primary care

Pharmacoepidemiology and Drug Safety ◽

10.1002/pds.4263 ◽

2017 ◽

Vol 26 (11) ◽

pp. 1347-1356 ◽

Cited By ~ 7

Author(s):

K. Schmidt-Mende ◽

M. Andersen ◽

B. Wettermark ◽

J. Hasselström

Keyword(s):

Primary Care ◽

Randomized Controlled Trial ◽

Elderly Patients ◽

Controlled Trial ◽

Open Label ◽

Healthcare Consumption ◽

Randomized Controlled ◽

Medication Reviews ◽

Cluster Randomized ◽

Acute Healthcare

Download Full-text

Clinical efficacy and cognitive side effects of bifrontal versus right unilateral electroconvulsive therapy (ECT): A short-term randomised controlled trial in pharmaco-resistant major depression

Journal of Affective Disorders ◽

10.1016/j.jad.2006.11.012 ◽

2007 ◽

Vol 101 (1-3) ◽

pp. 149-157 ◽

Cited By ~ 35

Author(s):

Gerhard W. Eschweiler ◽

Reinhard Vonthein ◽

Ruediger Bode ◽

Michael Huell ◽

Andreas Conca ◽

...

Keyword(s):

Side Effects ◽

Major Depression ◽

Randomised Controlled Trial ◽

Clinical Efficacy ◽

Electroconvulsive Therapy ◽

Controlled Trial ◽

Short Term ◽

Randomised Controlled ◽

Cognitive Side Effects

Download Full-text

Efficacy and Tolerability of Mirtazapine versus Paroxetine in the Treatment of Major Depressive Disorder

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s7632 ◽

2012 ◽

Vol 4 ◽

pp. CMT.S7632

Author(s):

Alexandre González Rodriguez ◽

Cristóbal Gastó Ferrer ◽

Victor Navarro Odriozola

Keyword(s):

Clinical Trial ◽

Major Depressive Disorder ◽

Major Depression ◽

Depressive Disorder ◽

Controlled Trial ◽

Assessment Tools ◽

Publication Type ◽

Open Label ◽

Major Depressive ◽

Randomized Controlled

Objective To compare the efficacy and tolerability of paroxetine and mirtazapine in the treatment of major depression. Data sources Searches were conducted to identify studies through Medline (1980-2011), PsycInfo (1980-2011) and PubMed databases up to June 2011. The searches were not restricted to publication type or clinical trial design. Study Selection A clinical trial was included if it described a trial of paroxetine versus mirtazapine in patients with major depression, based on the research evidence of reviews. Data Abstraction Three assessors analyzed the quality of the trials and extracted study design data, trial features, efficacy and toler-ability assessment tools, discontinuation reasons for both antidepressants and remitter and responder rates. Results We included six randomized controlled trials, one open-label, randomized controlled trial and four systematic reviews and metaanalysis. Rates of remission and response between mirtazapine and paroxetine were compared: at the beginning (1-2 weeks) there were statistically significant differences in mirtazapine treated patients, but these were not found at the end of assessment period (6-8 weeks). Discontinuation rates between the two drugs showed no differences, with an adverse event profile characteristic of each drug. Conclusions Mirtazapine and paroxetine were equally effective and well-tolerated in major depressive disorder. Differences in effectiveness were only observed in the first or second week of treatment when mirtazapine showed earlier onset of action.

Download Full-text

Cost-effectiveness of interpersonal psychotherapy for elderly primary care patients with major depression

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462307070572 ◽

2007 ◽

Vol 23 (4) ◽

pp. 480-487 ◽

Cited By ~ 13

Author(s):

Judith E. Bosmans ◽

Digna J. F. van Schaik ◽

Martijn W. Heymans ◽

Harm W. J. van Marwijk ◽

Hein P. J. van Hout ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Major Depression ◽

Elderly Patients ◽

Health Workers ◽

Controlled Trial ◽

Interpersonal Psychotherapy ◽

Future Research ◽

Depressed Patients ◽

The Cost

Objectives:Major depression is common in elderly patients. Interpersonal psychotherapy (IPT) is a potentially effective treatment for depressed elderly patients. The objective of this study was to evaluate the cost-effectiveness of IPT delivered by mental health workers in primary care practices, for depressed patients 55 years of age and older identified by screening, in comparison with care as usual (CAU).Methods:We conducted a full economic evaluation alongside a randomized controlled trial comparing IPT with CAU. Outcome measures were depressive symptoms, presence of major depression, and quality of life. Resource use was measured from a societal perspective over a 12-month period by cost diaries. Multiple imputation and bootstrapping were used to analyze the data.Results:At 6 and 12 months, the differences in clinical outcomes between IPT and CAU were small and nonsignificant. Total costs at 12 months were €5,753 in the IPT group and €4,984 in the CAU group (mean difference, €769; 95 percent confidence interval, −2,459 – 3,433). Cost-effectiveness planes indicated that there was much uncertainty around the cost-effectiveness ratios.Conclusions:Based on these results, provision of IPT in primary care to elderly depressed patients was not cost-effective in comparison to CAU. Future research should focus on improvement of patient selection and treatments that have more robust effects in the acute and maintenance phase of treatment.

Download Full-text