MECT Plus Pharmacotherapy Versus Pharmacotherapy Alone: Small Study From Spain

 Out on PubMed, from investigators in Spain, is this study:

The abstract is below:

Abstract: Few systematic evaluations have been performed of the efficacy of electroconvulsive therapy (ECT) as a relapse prevention strategy in major depressive disorder (MDD). This is a single-blind, multicenter, randomized controlled trial to compare the efficacy and tolerability of pharmacotherapy plus maintenance ECT (M-Pharm/ECT) versus pharmacotherapy alone (M-Pharm)

in the prevention of MDD relapse. Subjects with MDD who had remitted with bilateral acute ECT (n = 37) were randomly assigned to receive M-Pharm/ECT (n = 19, 14 treatments) or M-Pharm (n = 18) for nine months. The subjects were followed up for 15 months. The main outcome was relapse of depression, defined as a score of 18 or more on the Hamilton Depression Rating Scale. At nine months, 35% of the subjects treated with M-Pharm/ECT relapsed as compared with 61% of the patients treated with M-Pharm. No statistically significant differences between groups were indicated by either Kaplan–Meier or Cox proportional hazards regression analyses. The subjects without psychotic features were at higher risk of relapse. There were no statistically significant differences in the MMSE scores of the two groups at the end of the study. Further studies are needed to better

define the indications for M-ECT in order to improve its efficacy as a relapse prevention strategy.

Keywords: electroconvulsive therapy; major depressive disorder; prevention; relapse; recurrence; maintenance

 

And from the text:

 We consider that the lack of statistically significant differences may be mainly due

to the low statistical power. Therefore, the absence of statistically significant differences should not be categorically interpreted as a lack of clinical relevance of M-ECT. Despite the limited statistical power, some potential results of our study, such as the outcomes in subjects with psychotic symptoms and in residual depressive symptoms, may be clinically significant and may support the use of M-ECT, especially in cases of severe illness.

 Conclusions

 In line with Kellner et al. [11 ,12 ], our data demonstrate moderate protection against depressive relapse using both long-term treatment options, but do not provide statistical evidence to suggest that one treatment option is more effective in preventing relapse than the other. Early intensive individual therapeutic interventions are needed in depressed subjects requiring ECT in the acute phase in order to prevent future relapses, as are further studies designed to identify predictors of relapse after recovery from an episode of major

depression with acute ECT and to define the indications for M-ECT more precisely.

This is a carefully conducted and well presented study. The conclusions are, however, severely limited by the very small sample size (a priori power calculation requiring n=108, actual n= 37). Interesting design features include 14 ECT over 9 months, with total 15-month follow up. The patient sample included 58% with psychotic features, extremely high, even for a cohort of ECT patients; and the psychotic patients fared better.

We thank the authors for the careful review of the CORE and CORE/PRIDE studies.

The data from this study are probably best considered useful to further demonstrate the good tolerability of maintenance ECT.

For followers of the relapse prevention literature a full read will be ~ 15 minutes.