ECT: Alone or with Medication?

Because ECT increases brain concentrations of medications via a transient breakdown of the blood–brain barrier, clinicians are often unsure whether to discontinue medications during ECT. In a 4-year study, 319 patients with major depression discontinued their existing medications and were randomized to either bilateral ECT (BL; 1.5 times the seizure threshold) or right unilateral ECT (RUL; 6 times the seizure threshold), and to nortriptyline (mean serum level, 82 ng/mL), venlafaxine (mean dose, 177 mg/day), or placebo.

ECT/nortriptyline (but not ECT/venlafaxine) produced significantly greater reductions in depression-rating scores than ECT/placebo, although the difference in mean posttreatment scores between the nortriptyline and placebo gro…