This is a revision of a Geriatric Mental Health Academic Award. This Academic Investigator Award will provide the educational experience and mentorship necessary for the principal investigator to develop as a contributing clinical scientist in the areas of electroconvulsive therapy (ECT) and depression in the elderly. Clinical depression occurs commonly in the elderly. ECT is the treatment of choice when the elderly cannot tolerate or do not respond to antidepressant medication. The primary side effect of ECT in the elderly is reversible cognitive impairment. The cognitive side effects can be reduced by using brief pulse, right unilateral ECT. More recent efforts to further improve the efficacy of ECT while reducing the cognitive side effects have focused on strategies to dose the intensity of the electrical stimulus to correspond to the patient's requirement for an electrically induced seizure (seizure threshold). The seizure threshold varies widely between subjects; a stimulus dose far in excess of threshold contributes to side effects while too low a dose will not have antidepressant activity. This project will randomize elderly depressed patients to receive either a fixed, high dose stimulus (which is the standard in the U.S.) or a stimulus dose titrated only moderately in excess of the individual's seizure threshold. The difference between these two groups in the rate of antidepressant response and the severity of cognitive side effects will be measured. I predict that titrated ECT will result in less cognitive side effects in the elderly than fixed dose ECT. The academic portion of this proposal will provide for class work in statistics and epidemiology. Further, this proposal will allow active study and dialogue with Drs. Burton Reifler, Harold Sackeim, Richard Weiner, David Reboussin, and Frank Wood who are experts in the areas of dementia, depression, ECT, and biostatistics cognitive testing. Completion of the academic portion of this proposal will provide the tools necessary to complete the scientific project and develop as an investigator in geriatric depression and treatment.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Academic/Teacher Award (ATA) (K07)
Project #
Application #
Study Section
Mental Disorders of Aging Review Committee (MDA)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Wake Forest University Health Sciences
Schools of Medicine
United States
Zip Code
Rosenquist, Peter B; Dunn, Aaron; Rapp, Stephen et al. (2006) What predicts patients' expressed likelihood of choosing electroconvulsive therapy as a future treatment option? J ECT 22:33-7
McCall, W Vaughn; Dunn, Aaron; Rosenquist, Peter B (2004) Quality of life and function after electroconvulsive therapy. Br J Psychiatry 185:405-9
Iodice, Aline J; Dunn, Aaron G; Rosenquist, Peter et al. (2003) Stability over time of patients' attitudes toward ECT. Psychiatry Res 117:89-91
McCall, W Vaughn; Dunn, Aaron G (2003) Cognitive deficits are associated with functional impairment in severely depressed patients. Psychiatry Res 121:179-84
McCall, W Vaughn; Dunn, Aaron G; Rosenquist, Peter et al. (2002) Proxy validation of patient self-reports of ADL and IADL function before and after electroconvulsive therapy. J ECT 18:74-9
McCall, W Vaughn; Dunn, Aaron; Rosenquist, Peter B et al. (2002) Markedly suprathreshold right unilateral ECT versus minimally suprathreshold bilateral ECT: antidepressant and memory effects. J ECT 18:126-9
McCall, W V; Reboussin, B A; Cohen, W et al. (2001) Electroconvulsive therapy is associated with superior symptomatic and functional change in depressed patients after psychiatric hospitalization. J Affect Disord 63:17-25
McCall, W V; Reboussin, B A; Rapp, S R (2001) Social support increases in the year after inpatient treatment of depression. J Psychiatr Res 35:105-10
McCall, W V (2001) A psychiatric perspective on insomnia. J Clin Psychiatry 62 Suppl 10:27-32
McCall, W V; Dickerson, L A (2001) The outcome of 369 ECT consultations. J ECT 17:50-2

Showing the most recent 10 out of 24 publications