Prolonging Remission in Depressed Elderly (PRIDE).
Here we will test a newly developed Symptom-Titrated, Algorithm-Based, Longitudinal ECT (STABLE)
treatment schedule. STABLE incorporates both an initial brief fixed taper schedule, followed by a symptom
driven, flexible component for continuation ECT, in which treatment frequency is individualized based on
symptom expression in each patient. The algorithm is enhanced by case management and intensive clinical
contact to detect early signs of symptom re-emergence, and to detect potentially treatment-interfering side
effects (cognition) that might lead to dropout.
Patients who remit from Phase I ECT will move into either the Phase II STABLE or PHARM arm of study.To optimize post-ECT pharmacotherapy, we add Li augmentation of VLF since Li-augmented antidepressant treatment was more effective than antidepressant monotherapy in maintaining remission.31 Li is not initiated until after acute phase (Phase 1) ECT is completed due to the potential risk that has been attributed to the combination of ECT+Li, when Li isused at full therapeutic doses. In Phase 2, Li is discontinued a minimum of 24 hours before each ECT to
decrease serum levels. This is consistent with accepted standards of clinical practice.
(a) DSM-IV-TR diagnosis of major depressive episode, unipolar, based on SCID-I
(b) Pretreatment HRSD24 score of 21
(c) Age 60 years or older
(d) ECT is clinically indicated
(e) Patient competent to provide informed consent