Long-term outcome after ECT for catatonic depression

This is the initial report of the course of major depression with catatonic features after hospitalization.

Telephone interviews and ratings were conducted 3-7 years after response to inpatient electroconvulsive therapy (ECT) for such catatonic depression. This was done for all 19 followable patients treated over a particular 4-year period. All had received left anterior right temporal brief-pulse ECT. Prior to data examination, we constructed rules to classify medications as antimelancholic. These rules led to the inclusion of lithium, tricyclics, bupropion, and venlafaxine in this antimelancholic classification and to the exclusion of selective serotonin reuptake inhibitors.

Ten of the 13 patients discharged on antimelancholic medication (AMM) had good function on follow-up and no more than one rehospitalization. In contrast, none of the six patients in the other group had as good an outcome (p = 0.004, corrected chi2 = 8.26). The AMM group had no deaths, but three patients in the other group died of acute cardiopulmonary causes (p = 0.015). In most cases, catatonia and depression were not identified by informant interview on follow-up.

ECT followed by AMM usually led to long-term outcome that was good and better than without such medication. Although benzodiazepines can acutely diminish catatonia, we found no relevant long-term study; accordingly, long-term benzodiazepine use in catatonia is speculative.