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No difference in depression relapse rates between maintenance electroconvulsive therapy and lithium plus nortriptyline

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 Q How effective are electroconvulsive therapy or lithium carbonate plus nortriptyline hydrochloride as maintenance treatments in major depression?


Embedded ImageDesign:

Randomised controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:


Embedded ImageFollow-up period:

Six months (treatment period only).

Embedded ImageSetting:

Five academic medical centres (outpatient psychiatry clinics) in the US; 1997–2004.

Embedded ImagePatients:

Phase 1 (acute non-randomised treatment): 531 people aged 18–85 years with primary DSM-IV major depression (24-item Hamilton Rating Scale for Depression (HRSD) total score ⩾21) referred for bilateral electroconvulsive therapy (ECT). Phase 2 (maintenance treatment): 201 people with remission in phase 1 (⩾60% decrease from baseline in HRSD total score and HRSD score ⩽10 on two consecutive ratings), an HRSD score ⩽10 or less for 1 week without psychotropic medication, and modified Mini-Mental State Examination (mMMSE) score ⩾21. Exclusion criteria: ECT in 3 months before phase 1, medical conditions contraindicating study treatments, substance dependence in last 12 months, or disorders affecting cognition.

Embedded ImageIntervention:

ECT (10 sessions: once weekly …

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