Although electroconvulsive therapy (ECT) is an effective treatment for depression, preventing relapse after successful ECT remains a major challenge. In the PRASED-study, a large multicentre RCT, we evaluate the effectiveness of three strategies to reduce relapse: an algorithm-based symptom-driven form of maintenance-ECT (M-ECT), with antidepressants, with or without lithium.
In the four treatment centers, patients that are referred for ECT for depression will be screened for eligibility. In phase 1 300 patients are treated with an acute course of brief pulse ECT, combined with open label nortriptyline or venlafaxine. Patients that achieve remission, are considered eligible for phase 2 of the study. In this continuation phase, open label antidepressants are continued and algorithm-based, symptom-driven M-ECT is started for the next six months. Patients will be randomized to receive either lithium or not. After six months, patients enter phase 3, a naturalistic follow-up of mood at 3 and 6 months after completion of phase 2.
The combination of antidepressants, personalized M-ECT and lithium has been studied in an elderly population and proved to be very effective, but the efficacy in a severely depressed population of all ages has never been assessed. This project holds great promise for reducing relapse rates after successful ECT, thereby being of potential impact for a vulnerable group of patients with an often recurring and debilitating major depressive disorder. Apart from a significant positive medical impact, reducing relapse rates eventually also has a socio-economic impact by reducing health care costs.