Most studies of trends in
antidepressant pharmacotherapy have focused on relatively mildly ill, nonpyschotic outpatients. In this report, we provide detailed information on psychotropic use among patients with
unipolar depression participating in a large, multisite electroconculsive
therapy (ECT) study. Adequacy of
antidepressant medication trials was assessed with the
Antidepressant Treatment History Form. Among patients with nonpsychotic depression, 27% (60/220) had not had an adequate trial of an
antidepressant before ECT, and 63% (139/220) had had at least one inadequate trial. Surprisingly, 33% (79/243) of nonpsychotic patients had been prescribed an
antipsychotic. Among patients with psychotic depression, 95% (101/106) had not been given an adequate combination of an
antidepressant and
antipsychotic agent, mostly due to low doses of the latter class. Among all patients in the trial, 61% (213/352) had been prescribed at least one
benzodiazepine, and only 7% (24/352) had been given a
lithium augmentation trial. Use of
hypnotic agents and
anticonvulsants was common. In conclusion, patients with severe depression referred for ECT with a unipolar depressive episode have high rates of psychotropic usage, much of which is inadequate.