RELAPSE PREVENTION BY MEANS OF PAROXETINE IN ECT-TREATED PATIENTS WITH MAJOR DEPRESSION - A COMPARISON WITH IMIPRAMINE AND PLACEBO IN MEDIUM-TERM CONTINUATION THERAPY

In-patients with severe major depression were treated in the acute pha se with electroconvulsive therapy (ECT) in combination with antidepres sants. The drug treatment consisted of two randomized trials which wer e both extended into the post-ECT continuation phase. Patients with el ectrocardiological impairment were randomized to either 30 mg paroxeti ne daily or placebo under blind conditions. Patients without electroca rdiological impairment were randomized to either 30 mg paroxetine dail y or 150 mg imipramine daily. There was a high level of agreement betw een the Hamilton Depression Scale and the Melancholia Scale, demonstra ting that the patients treated with ECT plus imipramine in the acute p hase showed greater symptom reduction than those treated with ECT plus paroxetine. However, in the post-ECT phase paroxetine was superior to both imipramine and placebo in preventing relapse. Thus in the post-E CT phase 65% of the placebo-treated patients relapsed, compared to 30% of the imipramine-treated patients and 10% of the paroxetine-treated patients. The psychometric analysis of the Melancholia Scale in the co ntinuation or post-ECT phase showed that relapsing patients displayed a pattern with lack of interests, impaired concentration, depressed mo od and anxiety among the less severe symptoms (first-compartment sympt oms). In other words, these symptoms represent the gate to full-blown depression (second-compartment symptoms). Serotonin-selective antidepr essants such as paroxetine appear to be more effective in controlling the first-compartment symptoms.