Aj. Flint et Sl. Rifat, THE TREATMENT OF PSYCHOTIC DEPRESSION IN LATER LIFE - A COMPARISON OFPHARMACOTHERAPY AND ECT, International journal of geriatric psychiatry, 13(1), 1998, pp. 23-28
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.