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Anti-Depressive Electroconvulsive Effect Heightened By Calcium Channel Blocker

Depressed patients on a calcium channel blocker have a significantly better acute anti-depressant effect from standard electroconvulsive therapy than patients on placebo.

These anti-depressant effects are demonstrated by results from the Hamilton Depression Rating Scale and the Montgomery-Asberg Depression Rating Scale.

"Similar differences were observed for the Beck Depression Inventory, but they were not statistically significant," North American researchers report.

They randomly assigned a lipid-soluble calcium channel blocker (CCB), nicardipine, or placebo to 26 patients with major depressive disorder who were receiving electroconvulsive therapy (ECT). These patients did not have a pre-existing neurological impairment.

Researchers administered the three depression scales to patients as well as the Mini-Mental State Examination and a comprehensive battery of neuropsychological tests prior to ECT, at its completion and six months after its completion.

"Compared with patients receiving placebo, patients taking nicardipine had significantly lower scores on the Hamilton and Montgomery-Asberg, but not the Beck Depression rating scale scores at the completion of ECT," say researchers from the University of Colorado in Denver and the University of Texas at Dallas.

"There were no differences between placebo and nicardipine groups in depression scores six months after ECT."

Investigators also point out that participants' cognitive function declined over the course of ECT. Cognition in both groups then improved over the next six months.

"Changes were statistically significant for only two sub-tests on the neuropsychological battery," they note.

"With standard practice parameters, ECT did not produce enough sufficient cognitive impairment in this sample to detect any cognitive benefit of nicardipine.

"Treatment of cognitive dysfunction therefore may not be necessary for patients who are not at risk for severe cognitive side effects of ECT."

But the researchers suggest that studies of cognitive impairment treatments should be done in patients having risk factors for more severe cognitive impairment. They include geriatric patients and patients with a history of interictal delirium from prior ECT therapy in this category.
Journal of ECT, 2001; 17: 3-10. "Nicardipine Improves the Antidepressant Action of ECT But Does Not Improve Cognition"

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