Toward individualized post-electroconvulsive therapy care: piloting the Symptom-Titrated, Algorithm-Based Longitudinal ECT (STABLE) intervention.

The Journal of ECT
S H LisanbyCharles H Kellner

Abstract

Effective strategies to prolong remission after electroconvulsive therapy (ECT) are urgently needed. Fixed schedules for continuation ECT (C-ECT) cannot adapt to early signs of impending relapse. Symptom-Titrated, Algorithm-Based Longitudinal ECT (STABLE) is proposed as a novel patient-focused approach to individualize the ECT schedule. In STABLE, the ECT schedule adapts to symptom fluctuations to prevent overtreatment of those who do not need it and to recapture response in those who might have otherwise relapsed with a rigid dosing schedule. Here we back-test STABLE to optimize the algorithm for subsequent testing in a prospective trial. Three variations of the STABLE algorithm, differing in cutoff points to trigger or withhold additional ECT, were back-tested in a data set of 89 patients randomized to the C-ECT arm in the CORE (Consortium for Research on ECT) Study comparing C-ECT with combination pharmacotherapy. The selected algorithm identified 100% of patients who ultimately relapsed as requiring additional ECT at an average of 2.2 weeks before relapse, while exposing 20% of sustained remitters to additional ECT. Other variations either failed to capture impending relapse or exposed an unacceptably large percentage of pa...Continue Reading

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Citations

Jun 19, 2013·Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology·Ana JelovacDeclan M McLoughlin
Aug 4, 2011·Neuropsychobiology·Georgios PetridesMatthew V Rudorfer
Sep 6, 2008·The Journal of ECT·Charles KellnerUNKNOWN Consortium for Research on ECT (CORE) Investigator Group
Sep 5, 2009·The Journal of ECT·Chittaranjan Andrade, Rajiv Radhakrishnan
Sep 2, 2010·The Journal of ECT·Kenneth TrevinoMustafa M Husain
Oct 22, 2011·Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række·Kjell Martin Moksnes
Jan 22, 2009·Perspectives in Psychiatric Care·Norman L Keltner, Deborah J Boschini
Jul 26, 2018·The Journal of ECT·Samuel H BailineGeorgios Petrides
Oct 28, 2011·Expert Review of Medical Devices·Kate E Hoy, Paul B Fitzgerald
Jun 20, 2020·The Journal of ECT·Clémence CabelguenSamuel Bulteau
Jun 3, 2021·The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry·Sarah H LisanbyUNKNOWN Prolonging Remission in Depressed Elderly (PRIDE) Work Group
Jun 5, 2021·Acta Psychiatrica Scandinavica·Simon LambrichtsPascal Sienaert

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