Medication response to ECT-resistant melancholic patients.

During an ongoing study on potential neurochemical and neuroendocrine predictors of recovery after ECT, it was observed that depressed patients with unfavorable response to ECT, improved consequently with antidepressants alone or in combination and in some cases with the addition of neuroleptics or lithium salts. 13 female depressed patients with melancholia (DSM-III criteria), who had proven resistant to electroconvulsive therapy (ECT) and showed marked improvement with subsequent psychopharmacologic regimens, are described. In not less than 2 months after the last ECT, remission was achieved with a heterocyclic antidepressant (HCA) alone (3 patients) combined infusion of chlorimipramine and maprotiline (3 patients) combined HCAs-antipsychotics (4 patients) and HCAs in combination with lithium (3 patients). It is worth noting that certain depressed patients improved markedly with drugs which had poor results at the same doses before ECT. Confirmation of these observations by prospective studies would provide novel therapeutic capabilities and clues about the mode of action of this controversial treatment.