Medication Resistance and ECT. Is there a problem?

by Walter van den Broek

The indication for ECT has changed: Medication Resistant Depression.

Should you worry about that?

You’re concerned about medication resistance and response to ECT

p=0.004

p<0.05

Prudic, J et al. Journal of Psychiatric Research 1990

This didn’t help to resolve your concern

ATHF<3, n=18 ATHF 3 or more, n=36

Response 94% 64%

Prudic, J. et al. Am J Psychiatry, 1996

Medication resistance according to the ATHF does not influence remission and

response to subsequent ECT

Medication resistance according to the ATHF does not influence remission and

response to subsequent ECT

van den Broek, et al, Journal of Clin Psychopharmacology 2004

Co variables and their fate

Characteristics of the treatment

TCATCA LithiumLithium MAOMAO ECTECT

Medication resistance with TCA and lithium does not influence remission and response to subsequent ECT

Medication resistance with TCA and lithium does not influence remission and response to subsequent ECT

SSRIs are less efficacious than TCAs with depressed inpatients

Comparison of imipramine and lithium addition or fluvoxamine and lithium

addition

ECT after Lithium addition

Journal of Clin Psychiatry in press

Others haven’t found an influence of ATHF medication resistance on response to subsequent ECT

Others haven’t found an influence of ATHF medication resistance on response to subsequent ECT

Real World Patients?

Husain et al, Journal of Affective Disorders, 2004.

CORE

p=0.004

p<0.05

Prudic, J et al. Journal of Psychiatric Research 1990

ATHF<3, n=18 ATHF 3 or more, n=36

Response 94% 64%

Prudic, J. et al. Am J Psychiatry, 1996

Answers Anyone?