{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T14:04:20Z","timestamp":1783087460132,"version":"3.54.6"},"reference-count":46,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T00:00:00Z","timestamp":1599523200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Aust N Z J Psychiatry"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The primary indication for electroconvulsive therapy is medication-resistant major depression. There is some evidence that combining electroconvulsive therapy with an antidepressant, instead of electroconvulsive therapy monotherapy, might improve remission rates. However, data on this topic have not been systematically studied. We undertook a systematic review and meta-analysis to determine the effectiveness of an adjuvant antidepressant during electroconvulsive therapy for major depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Embase, Medline Ovid, Web of Science, Cochrane Central, PsychINFO Ovid and Google Scholar were searched up to January 2019. Randomized controlled trials and cohort studies reporting on the influence of an adjuvant antidepressant on the efficacy of electroconvulsive therapy for major depression were included. Authors independently screened records, extracted data and assessed study quality. We reported this systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Nine studies were included in the meta-analysis. The meta-analysis revealed a significant advantage of adjuvant antidepressants versus placebo. The overall effect size per category of antidepressant was as follows: tricyclic antidepressants: Hedges\u2019 g 0.32 (95% confidence interval: [0.14, 0.51]) ( k\u2009=\u20096) with low heterogeneity ( I\n                      <jats:sup>2<\/jats:sup>\n                      : 4%, p\u2009=\u20090.39); selective serotonin reuptake inhibitors\/serotonin noradrenaline reuptake inhibitors: Hedges\u2019 g 0.27 (95% confidence interval: [0.03, 0.52]) ( k\u2009=\u20092) with a lack of heterogeneity ( I\n                      <jats:sup>2<\/jats:sup>\n                      : 0%, p\u2009=\u20090.89); and monoamine oxidase inhibitors: Hedges\u2019 g 0.35 (95% confidence interval: [\u22120.07, 0.77]) with moderate heterogeneity ( I\n                      <jats:sup>2<\/jats:sup>\n                      : 43%, p\u2009=\u20090.17) ( k\u2009=\u20093).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>An adjuvant antidepressant enhances the efficacy of electroconvulsive therapy for major depression. Tricyclic antidepressants, selective serotonin reuptake inhibitors\/serotonin noradrenaline reuptake inhibitors and monoamine oxidase inhibitors showed the same effect size. However, the effect sizes of tricyclic antidepressants and monoamine oxidase inhibitors are most likely underestimated, due to insufficient doses in most of the included studies. We recommend the routine use of an adequately dosed antidepressant during electroconvulsive therapy for major depression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0004867420952543","type":"journal-article","created":{"date-parts":[[2020,9,9]],"date-time":"2020-09-09T02:59:26Z","timestamp":1599620366000},"page":"366-380","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":27,"title":["Influence of an adjuvant antidepressant on the efficacy of electroconvulsive therapy: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"55","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 MC \u2013 University Medical Centre, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid M","family":"Kamperman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Erasmus MC \u2013 University Medical Centre, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Witte JG","family":"Hoogendijk","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Erasmus MC \u2013 University Medical Centre, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom K","family":"Birkenh\u00e4ger","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Erasmus MC \u2013 University Medical Centre, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter W","family":"van den Broek","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Erasmus MC \u2013 University Medical Centre, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,9,8]]},"reference":[{"key":"bibr1-0004867420952543","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-3)","author":"American Psychiatric Association","year":"1980","edition":"3"},{"key":"bibr2-0004867420952543","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)","author":"American Psychiatric Association","year":"1994","edition":"4"},{"key":"bibr3-0004867420952543","volume-title":"Diagnostic and Statistical Manual of Mental Disorders: Text Revision (DSM-IV-TR)","author":"American Psychiatric Association","year":"2000"},{"key":"bibr4-0004867420952543","volume-title":"The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training and Privileging","author":"American Psychiatric Association","year":"2001","edition":"2"},{"key":"bibr5-0004867420952543","unstructured":"American Psychiatric Association (2010) Practice Guideline for the Treatment of Patients with Major Depressive Disorder. Available at: http:\/\/psychiatryonline.org\/guidelines.aspx (accessed 27 October 2019)."},{"key":"bibr6-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"bibr7-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(99)00092-0"},{"key":"bibr8-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1080\/15622970500213871"},{"key":"bibr9-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1097\/PRA.0000000000000192"},{"key":"bibr10-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-005-0098-0"},{"key":"bibr11-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1097\/00124509-200003000-00002"},{"key":"bibr12-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1017\/S1461145705006413"},{"key":"bibr13-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1097\/00124509-200412000-00013"},{"key":"bibr14-0004867420952543","volume-title":"Guideline on electroconvulsive therapy [Richtlijn elektroconvulsietherapie]","author":"Dutch Psychiatric Association","year":"2010"},{"key":"bibr15-0004867420952543","first-page":"89","volume":"95","author":"Duval S","year":"2000","journal-title":"Journal of the Acoustical Society of America"},{"key":"bibr16-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"bibr17-0004867420952543","first-page":"218","volume-title":"ECDEU Assessment Manual for Psychopharmacology","author":"Guy W","year":"1976"},{"key":"bibr18-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.23.1.56"},{"key":"bibr19-0004867420952543","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.14r09528"},{"key":"bibr20-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-08-057065-5.50010-5"},{"key":"bibr21-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e3181ee0f5f"},{"key":"bibr22-0004867420952543","unstructured":"Higgins JPT, Green S (eds) (2011) Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at: www.handbook.cochrane.org (accessed 02 September 2019)."},{"key":"bibr23-0004867420952543","first-page":"438","volume":"4","author":"Imlah NW","year":"1965","journal-title":"Neuropsychopharmacology"},{"key":"bibr24-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1996.tb09832.x"},{"key":"bibr25-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.117.541.667"},{"key":"bibr26-0004867420952543","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v66n0712"},{"key":"bibr27-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1996.tb09856.x"},{"key":"bibr28-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(99)00096-8"},{"key":"bibr29-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.005"},{"key":"bibr30-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.120.10.1003"},{"key":"bibr31-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.134.4.382"},{"key":"bibr32-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.107.451.994"},{"key":"bibr33-0004867420952543","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200216040-00003"},{"key":"bibr34-0004867420952543","unstructured":"National Institute for Health and Care Excellence (2003) Guidance on the use of electroconvulsive therapy. Available at: www.nice.org.uk\/guidance\/ta59 (accessed 27 October 2019)."},{"key":"bibr35-0004867420952543","first-page":"321","volume":"5","author":"Nelson JP","year":"1989","journal-title":"Convulsive therapy"},{"key":"bibr36-0004867420952543","unstructured":"Research Registry (2019) Influence of an adjuvant antidepressant on the efficacy of electroconvulsive therapy: A systematic review and meta-analysis (Reviewregistry763). Available at: www.researchregistry.com\/browse-the-registry#registryofsystematicreviewsmeta-analyses\/registryofsystematicreviewsmeta-analysesdetails\/5dc695a75b2ef10019a7acf1\/ (accessed 09 November 2019)."},{"key":"bibr37-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2009.75"},{"key":"bibr38-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.108.456.704"},{"key":"bibr39-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0b013e3180330059"},{"key":"bibr40-0004867420952543","volume-title":"Stata: Release 15","author":"Stata Corp","year":"2017"},{"key":"bibr41-0004867420952543","unstructured":"State of Queensland (2018) Guideline for the administration of electroconvulsive therapy. Available at: www.health.qld.gov.au\/__data\/assets\/pdf_file\/0028\/444763\/2018_Guideline-for-the-administration-of-Electroconvulsive-Therapy-v0.7.pdf (accessed 27 October 2019)."},{"key":"bibr42-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12705-5"},{"key":"bibr43-0004867420952543","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"bibr44-0004867420952543","unstructured":"Wilson DB (1999) Metaf Version 1.0: 06-01-1999: Meta-analysis Macros for SAS, SPSS, and Stata. Available at: http:\/\/mason.gmu.edu\/~dwilsonb\/ma.html (accessed 10 September 2019)."},{"key":"bibr45-0004867420952543","first-page":"331","volume":"4","author":"Wilson IC","year":"1963","journal-title":"Journal of Neuropsychiatry"},{"key":"bibr46-0004867420952543","volume-title":"ICD-10: International Classification of Diseases and Related Health Problems","author":"World Health Organization","year":"2010","edition":"10"}],"container-title":["Australian &amp; New Zealand Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0004867420952543","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0004867420952543","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0004867420952543","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:57:58Z","timestamp":1777373878000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0004867420952543"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,8]]},"references-count":46,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1177\/0004867420952543"],"URL":"https:\/\/doi.org\/10.1177\/0004867420952543","relation":{},"ISSN":["0004-8674","1440-1614"],"issn-type":[{"value":"0004-8674","type":"print"},{"value":"1440-1614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,8]]}}}