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Despite the recognized efficacy of electroconvulsive therapy (ECT) for geriatric depression, concerns about its cognitive effects limit its use. Searching for better techniques, investigators in an NIH-sponsored, two-phase, multisite study enrolled 240 severely depressed, unmedicated, unipolar patients aged ≥60 without cognitive, neurological, or medical impairment (Hamilton Rating Scale for Depression [HRSD] mean score, 31; mean age, 70; 58% women).
Almost 60% of patients had melancholia; 12% had psychotic symptoms. Phase I involved 3 treatments per week of high-dose (6× of seizure threshold), right unilateral, ultrabrief, pulsed ECT plus venlafaxine (starting dose, 37.5 mg/day; target, 225.0 mg/day). Remission was defined as HRSD scores ≤1…