OPTIMUM Trial For Geriatric Depression and Accompanying NEJM Editorial: ECT is MIA

 Out on PubMed, in the NEJM, are these two papers:Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression.

Lenze EJ, Mulsant BH, Roose SP, Lavretsky H, Reynolds CF 3rd, Blumberger DM, Brown PJ, Cristancho P, Flint AJ, Gebara MA, Gettinger TR, Lenard E, Miller JP, Nicol GE, Oughli HA, Pham VT, Rollman BL, Yang L, Karp JF.N Engl J Med. 2023 Mar 3. doi: 10.1056/NEJMoa2204462. Online ahead of print.PMID: 36867173



 Aripiprazole Augmentation in Older Persons with Treatment-Resistant Depression.
Lewis G, Lewis G.N Engl J Med. 2023 Mar 3. doi: 10.1056/NEJMe2301045. Online ahead of print.PMID: 36867178

A major treatment trial for geriatric depression (actually geriatric TRD) with poor remission rates, published this week in the NEJM, and an accompanying editorial fail to even mention ECT. Nothing, crickets...
The editorial, written by by two PhDs from University College, London, concludes:
The findings from this trial should help clinicians and older adult patients make informed decisions regarding the next steps, in the absence of a response to conventional pharmacologic approaches.

Well, informed decisions about next steps, particularly in the case of severe and/or urgent illness, include consideration of ECT.
While the omission of mention of ECT comes as no surprise, it is a reminder that ECT is not even on the radar of many clinicians who treat geriatric depression.

(My thanks to Randall Espinoza of UCLA for alerting me to these papers.)

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