Research Didier Schrijvers

Abstract

Electroconvulsive therapy (ECT) is an evidence-based treatment for difficult to treat, severe and sometimes life-threatening depressive episodes. It involves passing an electrical charge through the brain, via electrodes that are placed either on one side of the head (right unilateral RUL) or on both sides (bitemporal, BT), to induce a generalized seizure, under brief anesthesia. Usually, a mean number of 8 to12 treatment sessions are administered in an individual treatment course. Although results are conflicting, RUL ECT has been shown to be less effective than BT ECT, and induces fewer cognitive side-effects, whereas BT ECT is considered to have a faster antidepressant effect, but bears/entails a higher risk of cognitive side-effects. In patients showing response, improvement is mostly witnessed early in the treatment course, i.e. in the first 4 to 6 treatments. In non-responders, it is common practice to switch from RUL to BT electrode placement. However, no randomized controlled trial (RCT) data are available to support this ubiquitous clinical practice. We designed an RCT to address which treatment strategy (continue RUL ECT of switch to BT) speeds up recovery and has the least impact on memory function. The answerable clinical question can be structured as follows: - Patient: Patients treated with ECT for depression, showing no 'response' (≥50% decrease in depressive symptom severity compared to baseline) after 4 treatment sessions; - Intervention: Switch to BT ECT; - Comparison: Continue with RUL ECT; - Outcome: Depressive symptom severity and autobiographical memory (co-primary outcomes) after 8 treatment sessions. This project addresses the clinical question ECT-practitioners are faced with in daily clinical practice, and for which there is no consistent empirical evidence available. Being the first-ever RCT on the switch from RUL ECT to BT ECT, this project will have an important impact on the clinical practice, guiding clinical decision making.

Researcher(s)

• Promoter: Schrijvers Didier
• Co-promoter: Van Diermen Linda

Research team(s)

• Collaborative Antwerp Psychiatric Research Institute (CAPRI)

Project type(s)

• Research Project

Abstract

Although electroconvulsive therapy (ECT) is an effective treatment for depression, preventing relapse after successful ECT remains a major challenge. In the PRASED-study, a large multicentre RCT, we evaluate the effectiveness of three strategies to reduce relapse: an algorithm-based symptom-driven form of maintenance-ECT (M-ECT), with antidepressants, with or without lithium. In the four treatment centers, patients that are referred for ECT for depression will be screened for eligibility. In phase 1 300 patients are treated with an acute course of brief pulse ECT, combined with open label nortriptyline or venlafaxine. Patients that achieve remission, are considered eligible for phase 2 of the study. In this continuation phase, open label antidepressants are continued and algorithm-based, symptom-driven M-ECT is started for the next six months. Patients will be randomized to receive either lithium or not. After six months, patients enter phase 3, a naturalistic follow-up of mood at 3 and 6 months after completion of phase 2. The combination of antidepressants, personalized M-ECT and lithium has been studied in an elderly population and proved to be very effective, but the efficacy in a severely depressed population of all ages has never been assessed. This project holds great promise for reducing relapse rates after successful ECT, thereby being of potential impact for a vulnerable group of patients with an often recurring and debilitating major depressive disorder. Apart from a significant positive medical impact, reducing relapse rates eventually also has a socio-economic impact by reducing health care costs.

Researcher(s)

• Promoter: Schrijvers Didier

Research team(s)

• Collaborative Antwerp Psychiatric Research Institute (CAPRI)

Project type(s)

• Research Project

Abstract

Although electroconvulsive therapy (ECT) is an effective treatment for depression, preventing relapse after successful ECT remains a major challenge. In the PRASED-study, a large multicentre RCT, we evaluate the effectiveness of three strategies to reduce relapse: an algorithm-based symptom-driven form of maintenance-ECT (M-ECT), with antidepressants, with or without lithium. In the four treatment centers, patients that are referred for ECT for depression will be screened for eligibility. In phase 1 300 patients are treated with an acute course of brief pulse ECT, combined with open label nortriptyline or venlafaxine. Patients that achieve remission, are considered eligible for phase 2 of the study. In this continuation phase, open label antidepressants are continued and algorithm-based, symptom-driven M-ECT is started for the next six months. Patients will be randomized to receive either lithium or not. After six months, patients enter phase 3, a naturalistic follow-up of mood at 3 and 6 months after completion of phase 2. The combination of antidepressants, personalized M-ECT and lithium has been studied in an elderly population and proved to be very effective, but the efficacy in a severely depressed population of all ages has never been assessed. This project holds great promise for reducing relapse rates after successful ECT, thereby being of potential impact for a vulnerable group of patients with an often recurring and debilitating major depressive disorder. Apart from a significant positive medical impact, reducing relapse rates eventually also has a socio-economic impact by reducing health care costs.

Researcher(s)

• Promoter: Schrijvers Didier
• Co-promoter: Van Diermen Linda

Research team(s)

• Collaborative Antwerp Psychiatric Research Institute (CAPRI)

Project type(s)

• Research Project