THE TREATMENT OF PSYCHOTIC DEPRESSION IN LATER LIFE - A COMPARISON OFPHARMACOTHERAPY AND ECT

Objective. Response to combination pharmacotherapy and to electroconvu lsive therapy (ECT) was evaluated in elderly patients with psychotic d epression. Method. Twenty-five patients, aged 60 years and older, with DSM-III-R unipolar psychotic major depression, were treated in an ope n, non-randomized fashion with either 6 weeks of nortriptyline and per phenazine (N = 8) or ECT (N = 17). Response was defined as a Hamilton score of less than or equal to 10 and the absence of delusions and hal lucinations. Patients who failed to respond to combined antidepressant -antipsychotic medication underwent 2 weeks of lithium augmentation. R esults. Two (25.0%) patients responded to the first 6 weeks of pharmac otherapy whereas 15 (88.2%) patients responded to ECT (Fisher's exact test, p = 0.004). Even after lithium augmentation, there was a trend f or patients tb be less responsive to medication than to ECT (50.0% ver sus 88.2%, Fisher's exact test, p = 0.059). Survival analysis, based o n 8 weeks of observation, demonstrated that patients took longer to re spond to pharmacotherapy than to ECT (mean (SE) of 7(0) weeks versus 4 (0) weeks; log rank chi(2) = 10.43, df = 1, p = 0.001).Conclusions. We found that elderly patients with psychotic depression had a significa ntly lower frequency of response to nortriptyline and perphenazine tha n to ECT. However, patients responded more slowly to pharmacotherapy t han to ECT and longer duration of treatment may have improved the outc ome of the medication group. These findings suggest the need for a ran domized controlled trial comparing the efficacies of drug treatment an d ECT in late life psychotic depression. (C) 1998 John Wiley & Sons, L td.