The treatment of psychotic depression in later life: A comparison ofpharmacotherapy and ECT
A.J. Flint
Bok Engelsk 1998
| Utgitt | 1998
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| Omfang | Side 23- 28
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| Opplysninger | Objective. Response to combination pharmacotherapy and toelectroconvulsive therapy (ECT) was evaluated in elderly patientswith psychotic depression.Method. Twenty-five patients, aged 60 years and older, with DSM-III-Runipolar psychotic major depression, were treated in an open, non-randomized fashion with either 6 weeks of nortriptyline andperphenazine (N = 8) or ECT (N = 17). Response was defined as aHamilton score of less than or equal to 10 and the absence ofdelusions and hallucinations. Patients who failed to respond tocombined antidepressant-antipsychotic medication underwent 2 weeks oflithium augmentation.Results. Two (25.0%) patients responded to the first 6 weeks ofpharmacotherapy whereas 15 (88.2%) patients responded to ECT(Fisher's exact test, p = 0.004). Even after lithium augmentation,there was a trend for patients tb be less responsive to medicationthan to ECT (50.0% versus 88.2%, Fisher's exact test, p = 0.059).Survival analysis, based on 8 weeks of observation, demonstrated thatpatients took longer to respond to pharmacotherapy than to ECT (mean(SE) of 7(0) weeks versus 4(0) weeks; log rank chi(2) = 10.43, df =1, p = 0.001).Conclusions. We found that elderly patients with psychotic depressionhad a significantly lower frequency of response to nortriptyline andperphenazine than to ECT. However, patients responded more slowly topharmacotherapy than to ECT and longer duration of treatment may haveimproved the outcome of the medication group. These findings suggestthe need for a randomized controlled trial comparing the efficaciesof drug treatment and ECT in late life psychotic depression. (C) 1998John Wiley & Sons, Ltd.
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