Review of Treatments For Late-Life Depression: ECT is Included

 Out on PubMed, from authors in Germany, is this review:

Therapy Strategies for Late-life Depression: A Review.

Piel C, Quante A.J Psychiatr Pract. 2023 Jan 1;29(1):15-30. doi: 10.1097/PRA.0000000000000678.PMID: 36649548 Review.
The abstract is copied below:

Background: Depression in the elderly requires different treatment options because therapies that are commonly used for depression in younger patients show different effects later in life. Treatment options for late-life depression (LLD) are summarized in this article.

Methods: A literature search in Medline/PubMed performed in June 2020 identified 83 relevant studies.

Results: Pharmacotherapy with selective serotonin reuptake inhibitors can be an effective first-line treatment in LLD, but >50% of elderly patients do not adequately respond. Switching to other selective serotonin reuptake inhibitors or augmenting with mood stabilizers or antipsychotics is often effective in achieving a therapeutic benefit. Severely depressed patients with a high risk of suicidal behavior can be treated with electroconvulsive therapy. Psychotherapy provides a measurable benefit alone and when combined with medication.

Limitations: LLD remains an underrepresented domain in research. Paucity of data concerning the effect of specific therapies for LLD, heterogeneity in the quality of study designs, overinterpretation of results from meta-analyses, and discrepancies between study results and guideline recommendations were often noted.

Conclusions: Treating LLD is complex, but there are several treatment options with good efficacy and tolerability. Some novel pharmaceuticals also show promise as potential antidepressants, but evidence for their efficacy and safety is still limited and based on only a few trials conducted to date.

The article is here.

And from the text:


And from the Discussion:


And from the Conclusions:










This is an excellent, comprehensive review of therapies for late-life depression (LLD). Naturally, it is mostly about pharmacotherapy. It is divided into sections about regular LLD and treatment-resistant LLD. ECT is given reasonable and adequate treatment. My only other comment is that ECT is not clearly enough distinguished from rTMS as a much more effective and proven therapy.

Comments

Post a Comment

Popular posts from this blog

ECT plus Antidepressants: a Review

Out on PubMed, from researchers in Rotterdam, The Netherlands, is this review: Influence of an adjuvant antidepressant on the efficacy of  electroconvulsive  therapy: A systematic review and meta-analysis. Pluijms EM, Kamperman AM, Hoogendijk WJ, Birkenhäger TK, van den Broek WW. Aust N Z J Psychiatry. 2020 Sep 8:4867420952543. doi: 10.1177/0004867420952543. Online ahead of print. PMID:  32900217 Here is the "Conclusion" section from the text: Our results suggest that an adjuvant antidepressant enhances the efficacy of ECT in patients with major depression. Although the included studies had some methodological limitations, effect sizes were consistently small to moderate. We speculate that modern-day controlled trials using adequately dosed TCAs and MAOIs will most likely result in larger effect sizes. From a clinical point of view, we prefer an adjuvant TCA to an adjuvant MAOI, since TCAs are generally safe to use with ECT ( American Psychiatric Association, 2001 ; ...
Read more

Clinical Phenotype of Behavioral-Variant Frontotemporal Dementia Reversed by ECT: A Case Report

Image
Out on PubMed, from authors in Germany, is this case report and literature review: Clinical Phenotype of Behavioral-Variant Frontotemporal Dementia Reversed by  ECT : A Case Report. Breitling B, Bartels C, Lange C, Bouter C, Falk HS, Wiltfang J, Zilles-Wegner D, Besse M. Neuropsychobiology. 2024 Dec 2:1-12. doi: 10.1159/000541668. Online ahead of print. PMID:  39622206 The abstract is copied below: Introduction: Diagnosis of frontotemporal dementia (FTD) remains difficult even in the presence of core clinical and imaging features. Furthermore, disease-modifying treatments are lacking. Case presentation: Here, we report a case of a patient with clinical and imaging features of FTD. Electroconvulsive therapy (ECT) was used to target affective and catatonic symptoms. After ECT, the patient showed improvements not only in affective symptoms but also in cognitive domains, leading to a marked improvement in the patient's level of functioning. Conclusion: Against the background of di...
Read more

Early Use of the Name "ECT"- Sacklers in 1949

Image
 "Classics in ECT" brings you this study from Creedmore State Hospital in 1949: Nonconvulsive biochemotherapy with histamine and electric convulsive therapy; a comparative study on hospitalized psychotics with a control  ECT  series. SACKLER AM, SACKLER MD, SACKLER RR. J Nerv Ment Dis. 1949 Sep;110(3):185-97. doi: 10.1097/00005053-194911030-00001. PMID:  18138865 The pdf is here . I originally choose this article as the earliest in PubMed to use the name, "ECT," although it also uses "electric [sic] convulsive therapy."  The very first PubMed "ECT" citation is from 1947, but it is written "E.C.T." and also reports a complication, so we prefer this one. Nomenclature aside, this turns out to be an interesting read, with what would now be considered a somewhat bizarre study comparing histamine therapy with ECT. Among the interesting details are the inclusion of a couple of patients with postpartum psychosis and the observation that longer ...
Read more