Classics in ECT: ECT's Superiority for Psychotic Depression, 1982

"Classics in ECT" brings you this study from 1982 from researchers at Cornell in New York City:

Psychotic vs. nonpsychotic depression: comparison of treatment response.

Brown RP, Frances A, Kocsis JH, Mann JJ.J Nerv Ment Dis. 1982 Oct;170(10):635-7. doi: 10.1097/00005053-198210000-00008.PMID: 6125562 

The abstract is copied below:

This retrospective study compared the treatment responses of 34 primary, unipolar depressives without psychotic features and 30 with psychotic features. Patients were diagnosed by Research Diagnostic Criteria and received trials of tricyclic antidepressants, antipsychotics, the combination of the two, electroconvulsive therapy, or placebo and psychotherapy. Only three of 18 psychotic patients vs. 17 of 23 nonpsychotic patients responded to antidepressants alone. Electroconvulsive therapy and the combination of antipsychotic and antidepressant medication gave better responses. These data suggest that major depressive disorder with psychotic features is best considered as a distinct subtype rather than a severe variant of major depression.

The pdf is here.

And from the text:

This medium-sized retrospective study from investigators at The Payne Whitney Clinic  of New York Hospital (three of whom are very well-known: Frances, Kocsis and Mann) forms an early part of the evidence base for the superiority of ECT in psychotic depression. 

The patients were inpatients between 1977-9, so antidepressant medications were still tricyclics, just before the SSRI era...

We now have much more data about the efficacy of ECT for psychotic depression, including the first CORE study. 

This is a nice, small, period piece, definitely worth a full read (~8 minutes).