Evaluation of Three Continuation Therapies After ECT Concerning Efficacy and Cognition in Severly Depressed Patients
Condition: Depression; Major Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional
Phase: Phase 1

Summary: 
      The purpose of this study is to evaluate three different continuation treatments after acute
      ECT concerning efficacy and impact on cognition in severly depressed patients.
    

Detailed description: 
      BACKGROUND While electroconvulsive therapy (ECT) in major depression is effective, high
      relapse rates and cognitive effects limit its long-term use. Continuation treatment after ECT
      with combinations of C-ECT or psychotherapy and medication may decrease relapse rates and
      cognitive side effects while changing cognitive psychological variables like dysfunctional
      attitudes in the long-term.

      CENTRAL RESEARCH QUESTIONS

        -  Evaluation of the efficacy of three continuation treatments aimed at preventing relapses
           after acute ECT

        -  Examination of the cognitive side effects and the changes of cognitive psychological
           variables during acute and continuation treatment

      METHODS In a prospective, randomized, controlled, long-term study we assign 60 depressed ECT
      responder either to antidepressant treatment alone, or C-ECT plus medication, or cognitive
      behavioral group therapy plus medication. Depressive symptoms and cognition were assessed
      before, during, immediately after acute ECT and two, four, six, and 12 months during
      continuation therapy.

      HYPOTHESES It is hypothesized that the use of combination continuation therapies after
      effective ECT leads to lower HAMD scores and lower relapse rates than the standard treatment
      with antidepressants alone after 6 months. In addition, we assume that the CBT group will
      establish more functional macro-patterns than the somatic treatments in the long term and
      will have the lowest HAMD scores and relapse rates after 1 year. With regard to the cognitive
      side effects, the autobiographical memory is expected to be the only specific part of memory
      being affected negatively by ECT in the short and long term.
    

Intervention name(s): TCAs, SSRIs, NARIs, SNRIs, Lithium; Electroconvulsive therapy; Cognitive behavioral group therapy
Intervention type(s): Drug; Procedure; Behavioral
Intervention description(s): Antidepressant, dosage, and duration are chosen due to the guidelines of the WFSBP (Bauer et al. 2002); ECT treatment is administered three times per week on non-successive weekdays and according to existing standards. Treatment lasts for at least three weeks (nine ECT sessions). Psychopharmacological treatment is continued during ECT treatment. Patients receive ultrabrief pulse (0.3 ms), unilateral treatment at a frequency of 40-100 Hertz. Stimulation is applied to the non-dominant hemisphere, according to the d'Elia electrode positioning paradigm. All patients are initially treated with right unilateral stimulation and in case of non-response switched to bilateral treatment. Stimulus intensity is chosen according to individual seizure threshold and administered at 2.5 to 6-fold intensity. During the ECT session, patients are anesthetized, under the influence of a muscle relaxant, and monitored regarding their vital functions.; The continuation-psychotherapy (continuation cognitive behavioral therapy, C-CBT) sample took part in a newly developed cognitive behavioral group therapy program called "EffECTive". This therapy program was developed within the EffECT-project (Brakemeier et al. 2005), to fit the specific target group of patients finished with acute ECT-treatment. EffECTive is a group therapy that combines several aspects of existing cognitive-behavioral depression manuals with new elements (e.g., the situational analysis from CBASP, McCullough 2000), to fit the target group. Therapy sessions were held once a week and include approximately 15 sessions until follow-up.
Intervention MeSH terms: Lithium Carbonate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: therapy resistant depression, severe depression