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Am J Psychiatry 1996; 153:985-992
Copyright © 1996 by American Psychiatric Association
Resistance to antidepressant medications and short-term clinical response to ECT
J Prudic, RF Haskett, B Mulsant, KM Malone, HM Pettinati, S Stephens, R Greenberg, SL Rifas and HA Sackeim
Department of Biological Psychiatry, New York State Psychiatric Institute, NY 10032, USA.
OBJECTIVE: Traditionally, it has been widely assumed that the likelihood of
response to ECT is independent of the adequacy of previous treatment with
antidepressant medications. However, recent research has raised the
possibility that medication-resistant patients with depression have a
poorer clinical ECT outcome than patients who have not failed previous
adequate medication trials. METHOD: Medication resistance of 100 patients
with primary, unipolar, nonpsychotic major depression was evaluated during
the index episode with the Antidepressant Treatment History Form. Patients
were recruited and treated with ECT at three sites; standardized ECT and
clinical assessment procedures were used. Clinical outcome was assessed
immediately and 1 week after completion of the ECT course. RESULTS:
Patients who previously had failed one or more adequate antidepressant
medication trials were less likely to respond to subsequent ECT than
patients not known to be medication resistant. This finding held within
each study site, whether clinical response was assessed categorically or in
terms of the magnitude of symptomatic improvement and after the authors
accounted for other potential predictors of clinical outcome. Resistance to
heterocyclic antidepressants predicted poorer outcome after ECT, while
resistance to selective serotonin reuptake inhibitors and monoamine oxidase
inhibitors did not show significant predictive relations. CONCLUSIONS:
While a substantial percentage of medication- resistant patients respond to
ECT, clinical outcome in this group is inferior to that of patients without
established medication resistance. The predictive power of medication
resistance is generalizable across diverse clinical settings, particularly
for heterocyclic antidepressants, which perhaps suggests an overlap in the
mechanisms of actions of ECT and this medication class.
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Resistance to Antidepressants Predicts Diminished ECT Response
Journal Watch Psychiatry,
October 1, 1996;
1996(1001):
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[Full Text]
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