CoChat
Sign Up
Cited by 471Electroconvulsive Therapy StudiesTreatment of Major DepressionBipolar Disorder and Treatment

Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression: A Multisite Study From the Consortium for Research in Electroconvulsive Therapy (CORE)

Open access
Kellner, Charles H., Knapp, Rebecca G., Petrides, Georgios, Rummans, Teresa A., Husain, Mustafa M., Rasmussen, Keith, Mueller, Martina, Bernstein, Hilary J. +9 more·2006·Archives of General Psychiatry
DOI 10.1001/archpsyc.63.12.1337PMC PMC3708140
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Although electroconvulsive therapy (ECT) has been shown to be extremely effective for the acute treatment of major depression, it has never been systematically assessed as a strategy for relapse prevention. OBJECTIVE: To evaluate the comparative efficacy of continuation ECT (C-ECT) and the combination of lithium carbonate plus nortriptyline hydrochloride (C-Pharm) in the prevention of depressive relapse. DESIGN: Multisite, randomized, parallel design, 6-month trial performed from 1997 to 2004. SETTING: Five academic medical centers and their outpatient psychiatry clinics. PATIENTS: Two hundred one patients with Structured Clinical Interview for DSM-IV-diagnosed unipolar depression who had remitted with a course of bilateral ECT. INTERVENTIONS: Random assignment to 2 treatment groups receiving either C-ECT (10 treatments) or C-Pharm for 6 months. MAIN OUTCOME MEASURE: Relapse of depression, compared between the C-ECT and C-Pharm groups. RESULTS: In the C-ECT group, 37.1% experienced disease relapse, 46.1% continued to have disease remission at the study end, and 16.8% dropped out of the study. In the C-Pharm group, 31.6% experienced disease relapse, 46.3% continued to have disease remission, and 22.1% dropped out of the study. Both Kaplan-Meier and Cox proportional hazards regression analyses indicated no statistically significant differences in overall survival curves and time to relapse for the groups. Mean +/- SD time to relapse for the C-ECT group was 9.1 +/- 7.0 weeks compared with 6.7 +/- 4.6 weeks for the C-Pharm group (P = .13). Both groups had relapse proportions significantly lower than a historical placebo control from a similarly designed study. CONCLUSIONS: Both C-ECT and C-Pharm were shown to be superior to a historical placebo control, but both had limited efficacy, with more than half of patients either experiencing disease relapse or dropping out of the study. Even more effective strategies for relapse prevention in mood disorders are urgently needed.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/archpsyc.63.12.1337

Cites

29 of 29 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Findings of two identified studies favored ECT added or compared with medicinal treatments.

    “Their findings favored ECT added or compared with medicinal treatments (Gagne et al., 2000; Kellner et al., 2006).”

    From Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials (2016) · cites this paper as Kellner et al., 2006

    The EFFICACY RESULTS section (page not provided) reports no statistically significant difference between continuation ECT and pharmacotherapy; relapse was 37.1% with ECT versus 31.6% with pharmacotherapy. The COMMENT section likewise says there was no statistical evidence that either treatment had greater efficacy. This study therefore does not support a finding favoring ECT over medication. (LLM, conf=0.90)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • One review reports incidence rates of withdrawal symptoms ranging from 27% to 86% (weighted average of 56%) based on individual reports in surveys, and another at 31% based on RCTs employing a withdrawal symptom scale.

    “One review reports incidence rates ranging from 27% to 86% (weighted average of 56%) based on individual reports in surveys 524 and another at 31% based on RCTs employing a withdrawal symptom scale. 527”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [524]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Petrides G, Fink M, Knapp R, Kellner C, Husain M, Rummans T, Fink M, Rush AJ, O'Connor K, Bernstein H. More robust response to ECT in psychotic com- pared to non-psychotic unipolar depressed patients: a CORE study report. J ECT. 2001;17:244-253.
  2. Sackeim HA. The cognitive effects of electroconvulsive therapy. In: Moos WH, Gamzu ER, Thai LF, eds. Cognitive Disorders: Pathophysiology and Treatment. New York, NY: Marcel Dekker; 1992:183-228.

Cited by

Sorted by citations

Related

Authors
Kellner, C. H., Knapp, R. G., Petrides, G., Rummans, T. A., Husain, M. M., Rasmussen, K., Mueller, M., Bernstein, H. J., O’Connor, K., Smith, G., Biggs, M., Bailine, S. H., Malur, C., Yim, E., McClintock, S., Sampson, S., & Fink, M.
Affiliations
  • Rutgers New Jersey Medical School (US)
  • Medical University of South Carolina (US)
  • Rutgers, The State University of New Jersey (US)
  • Mayo Clinic (US)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2006-12-01
Volume
63
Issue
12
Pages
1337-44
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.63.12.1337
PMC
PMC3708140
OpenAlex
W2036261911
Cited by
471
References
29
Citations by year
2026: 14 · 2025: 11 · 2024: 15 · 2023: 17 · 2022: 16 · 2021: 22 · 2020: 22 · 2019: 37 · 2018: 27 · 2017: 20 · 2016: 27 · 2015: 29 · 2014: 20 · 2013: 28 · 2012: 31
FWCI
15.93
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Mayo Foundation for Medical Education and Research
  • National Institute of Mental Health (R10MH055495, R01MH055484, U01MH055495, R10MH055484, R01MH055486, R01MH055495, R01MH055489, R10MH055486, R10MH055489)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
relapse prevention, major depressive disorder, lithium carbonate, nortriptyline, pharmacotherapy, remitted depression, time to relapse, treatment discontinuation
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Ambulatory Care, Antidepressive Agents, Major Depressive Disorder, Electroconvulsive Therapy, Female, Humans, Functional Laterality, Male, Middle Aged, Nortriptyline, Patient Dropouts, Research Design, Proportional Hazards Models, Lithium Carbonate, Treatment Outcome, Secondary Prevention

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review