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Am J Geriatr Psychiatry 16:498-505, June 2008
© 2008 American Association for Geriatric Psychiatry
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Regular Research Articles

Continuation/Maintenance Treatment with Nortriptyline Versus Combined Nortriptyline and ECT in Late-Life Psychotic Depression: A Two-Year Randomized Study

Victor Navarro, M.D., Ph.D., Cristóbal Gastó, M.D., Ph.D., Xavier Torres, Ph.D., Guillem Masana, M.D., Ph.D., Rafael Penadés, Ph.D., Joana Guarch, Ph.D., Mireia Vázquez, M.D., Montserrat Serra, M.D., Nuria Pujol, Ph.D., Luis Pintor, M.D., Ph.D., and Rosa Catalán, M.D., Ph.D.

From the Clinical Institute of Psychiatry and Psychology, Hospital Clinic, University of Barcelona, Spain; and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain.

Objective: The identification of effective continuation and maintenance strategies for elderly patients with psychotic depression is a critical issue that has not been fully explored. The aim of this study was to assess the tolerability and efficacy of continuation/maintenance electroconvulsive therapy (ECT) in elderly patients with psychotic depression after acute ECT remission.

Methods: The authors used a longitudinal, randomized, single-blind design to compare by survival analysis the 2-year outcome of two subgroups of elderly patients with psychotic unipolar depression who were ECT (plus nortriptyline) remitters. One group was treated with a continuation/maintenance nortriptyline regimen (N = 17) and the other with combined continuation/maintenance ECT plus nortriptyline (N = 16).

Results: Over 2 years of treatment in elderly, psychotic, unipolar depressed ECT (plus nortriptyline) remitters, the mean survival time was significantly longer in the combined ECT plus nortriptyline subgroup than in the nortriptyline subgroup. No differences were observed between treatments with regard to tolerability.

Conclusions: This study supports the judicious use of combined continuation/maintenance ECT and antidepressant treatment in elderly patients with psychotic unipolar depression who are ECT remitters.

Key Words: Elderly depression • psychotic • continuation ECT • maintenance ECT






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