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Electroconvulsive Therapy, Antimelancholic Drugs Benefit Catatonic Depressives

Long-term outcome of electroconvulsive therapy followed by antimelancholic medication is more successful in patients with major depression with catatonic features than use of electroconvulsive therapy alone.

North American researchers say they found electroconvulsive therapy (ECT) followed by antimelancholic medication (AMM) led to good outcomes for patients hospitalised with major catatonic depression. These outcomes were better than those seen in patients treated with ECT but without medication follow-up.

Investigators from Southern Illinois University in Springfield and East Carolina University in Greenville, North Carolina followed 19 catatonic depression patients treated with ECT over one four-year period.

They used telephone interviews and other ratings during three to seven years of follow-up.

Participants had all received left anterior right temporal brief-pulse ECT as inpatients.

Researchers constructed rules to classify medications as being antimelancholic. They included lithium, tricyclics, bupropion and venlafaxine. They excluded selective serotonin reuptake inhibitors.

A total of 10 of 13 patients discharged with AMMs had good function on follow-up, with no more than one re-hospitalisation each.

"In contrast, none of the six patients in the other group had as good an outcome," investigators report. Three patients in the non-medication group died of acute cardiopulmonary causes.

Researchers also commented on the possible use of benzodiazepines for catatonic depression therapy.

"Although benzodiazepines can acutely diminish catatonia, we found no relevant long-term study."

The researchers suggest that using the drugs for catatonia is speculative.
Journal of ECT, 2001; 17: 180-183 "Long-Term Outcome After ECT for Catatonic Depression"

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