What was learned: studies by the consortium for research in ECT (CORE) 1997-2011

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Medicine

Background:

• Electroconvulsive therapy (ECT) is a treatment for severe depression.
• The CORE studies investigated continuation ECT versus pharmacotherapy.
• Comparative studies examined electrode placement in ECT.

Purpose of the Study:

• To review findings from the CORE studies on electroconvulsive therapy (ECT) for unipolar depression.
• To compare continuation ECT with lithium and nortriptyline.
• To evaluate electrode placement techniques in ECT for unipolar and bipolar depression.

Main Methods:

• Review of 19 published reports from the CORE studies (1997-2011).
• Comparison with a parallel Columbia University Collaboration (CUC) study.
• Analysis of relapse rates, predictors of outcome, and technical aspects of ECT.

Main Results:

• Continuation ECT showed similar relapse rates to combined lithium and nortriptyline.
• Predictors of ECT outcome include psychosis, suicide risk, polarity, melancholia, atypical depression, and age.
• Bilateral electrode placement was found to be more efficient than other placements.

Conclusions:

• ECT is effective for both unipolar and bipolar depression.
• Continuation ECT is a viable alternative to pharmacotherapy for maintenance treatment.
• Findings provide criteria for optimizing patient selection, technique, and outcomes in ECT.