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Br J Psychiatry. 2015 Jan;206(1):67-71. doi: 10.1192/bjp.bp.114.148213. Epub 2014 Oct 16.

Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication.

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Harm-Pieter Spaans, MD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Pascal Sienaert, MD, PhD, Filip Bouckaert, MD, University Psychiatric Centre - Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium; Julia F. van den Berg, PhD, Esmée Verwijk, MSc, King H. Kho, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands; Max L. Stek, MD, PhD, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands; Rob M. Kok, MD, PhD, Parnassia Psychiatric Institute, The Hague, The Netherlands.



Severe depression can be a life-threatening disorder, especially in elderly patients. A fast-acting treatment is crucial for this group. Electroconvulsive therapy (ECT) may work faster than medication.


To compare the speed of remission using ECT v. medication in elderly in-patients.


The speed of remission in in-patients with a DSM-IV diagnosis of major depression (baseline MADRS score ≥20) was compared between 47 participants (mean age 74.0 years, s.d. = 7.4) from an ECT randomised controlled trial (RCT) and 81 participants (mean age 72.2 years, s.d. = 7.6) from a medication RCT (nortriptyline v. venlafaxine).


Mean time to remission was 3.1 weeks (s.d. = 1.1) for the ECT group and 4.0 weeks (s.d. = 1.0) for the medication group; the adjusted hazard ratio for remission within 5 weeks (ECT v. medication) was 3.4 (95% CI 1.9-6.2).


Considering the substantially higher speed of remission, ECT deserves a more prominent position in the treatment of elderly patients with severe depression.

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