{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T20:20:40Z","timestamp":1783023640733,"version":"3.54.6"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,2,18]],"date-time":"2022-02-18T00:00:00Z","timestamp":1645142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>There is limited evidence that adding an antidepressant to electroconvulsive therapy (ECT), compared with ECT monotherapy, improves outcomes. We aimed to determine whether the addition of nortriptyline to ECT enhances its efficacy and prevents post\u2010ECT relapse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a randomized, double\u2010blind, placebo\u2010controlled trial (RCT). Patients with major depressive disorder and an indication for ECT received either nortriptyline or placebo during a bilateral ECT course. Outcome measures were mean decrease in Hamilton Rating Scale for Depression (HRSD) score, response, remission, and time to response and remission. Patients who attained remission participated in a 1\u2010year follow\u2010up study with open\u2010label nortriptyline. Outcome measures were relapse and time to relapse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 47 patients in the RCT. In the nortriptyline group, 83% showed response, 74% attained remission, and the mean decrease in HRSD score was 21.6 points. In the placebo group these figures were, respectively, 81% (<jats:italic>p\u00a0<\/jats:italic>=\u00a00.945), 73% (<jats:italic>p\u00a0<\/jats:italic>=\u00a00.928) and 20.7 points (<jats:italic>p\u00a0<\/jats:italic>=\u00a00.748). Thirty\u2010one patients participated in the follow\u2010up study. In patients who had received nortriptyline during the RCT, 47% relapsed at a mean of 34.2\u00a0weeks. Patients who had received placebo showed similar treatment results. In both study phases, no statistically significant differences between the nortriptyline and the placebo group were found.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In our sample of severely depressed patients who were often medication resistant and suffering from psychotic depression, the addition of nortriptyline to ECT did not enhance its efficacy or prevent post\u2010ECT relapse. Encouragingly, even in these patients ECT was highly effective and relapse rates were relatively low.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acps.13408","type":"journal-article","created":{"date-parts":[[2022,2,13]],"date-time":"2022-02-13T04:23:37Z","timestamp":1644726217000},"page":"517-528","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Influence of adjuvant nortriptyline on the efficacy of electroconvulsive therapy: A randomized controlled trial and 1\u2010year follow\u2010up"],"prefix":"10.1111","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7514-0946","authenticated-orcid":false,"given":"Esther M.","family":"Pluijms","sequence":"first","affiliation":[{"name":"Department of Psychiatry Erasmus University Medical Centre Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4455-6492","authenticated-orcid":false,"given":"Astrid M.","family":"Kamperman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Erasmus University Medical Centre Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0225-4966","authenticated-orcid":false,"given":"Witte J. 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