OPTIMIZATION OF ELECTROCONVULSIVE THERAPY

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Purpose: Electroconvulsive therapy (ECT) providers are uncertain whether antidepressant medications should be continued during ECT, and what dose of electricity is best for the patient. This project will examine whether patients on antidepressant medications have different results after ECT compared with ECT patients who did not take these medications. We shall also examine whether medication status during ECT predicts the likelihood of relapse in the first 6 months after ECT. Subjects: 630 depressed adults in a multicenter trial. Approximately 30/year randomized at Wake Forest University. Methods and Measures: Patients will be randomized (like the flip of a coin) to receive either a high dose of electricity to the right side of their head or a low dose to both sides. They will simultaneously be randomized to placebo (like a sugar pill), venlafaxine, or nortriptyline during ECT. After ECT, all patients who responded and who had been on placebo shall receive either vanlafizine or nortriptyline. Finally, all responders to ECT shall have lithium added to their medication regimen. We will measure mood state, memory function, and quality of life at the end of ECT, and biweekly through 6 months after ECT. Blood levels of psychoactive medications shall be monitored throughout the study. Benefits and Risks: Participants shall get free medications and blood levels of medications throughout their participation in the protocol. Additionally, participants in the post-ECT follow up phase shall have free psychiatric office visits.