Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression - A multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE)
Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression - A multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE)
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DOI：
10.1001/archpsyc.63.12.1337
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发表时间：
2006-12-01
影响因子：
--
通讯作者：
Fink, Max
中科院分区：
文献类型：
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作者：
Kellner, Charles H.;Knapp, Rebecca G.;Fink, Max
背景：虽然电痉挛疗法（ECT）已被证明对重度抑郁症的急性治疗非常有效，但它从未被系统地评估为预防复发的策略。目的：评价持续电痉挛疗法（C-ECT）与碳酸锂联合盐酸去甲替林（C-Pharm）预防抑郁症复发的疗效比较。设计：多地点、随机、平行设计，1997 - 2004年6个月的试验。环境：五个学术医疗中心及其精神病学门诊。患者：采用结构化临床访谈法对经dsm - iv诊断的单极抑郁症进行治疗，并通过一个疗程的双侧电痉挛治疗得到缓解的2100例患者。干预措施：随机分为两个治疗组，接受C-ECT（10次治疗）或C-Pharm治疗6个月。主要观察指标：比较C-ECT组和C-Pharm组抑郁症复发率。结果：在C-ECT组中，37.1%的患者复发，46.1%的患者在研究结束时病情持续缓解，16.8%的患者退出研究。在C-Pharm组中，31.6%的患者复发，46.3%的患者病情持续缓解，22.1%的患者退出研究。Kaplan-Meier和Cox比例风险回归分析均显示，两组患者的总生存曲线和复发时间无统计学差异。C-ECT组到复发的平均+/- SD时间为9.1 +/- 7.0周，而C-Pharm组为6.7 +/- 4.6周（P= 0.13）。两组的复发比例都明显低于一项类似设计的研究中使用安慰剂的历史对照组。结论：C-ECT和C-Pharm均优于历史安慰剂对照，但两者的疗效有限，超过一半的患者要么经历疾病复发，要么退出研究。我们迫切需要更有效的策略来预防情绪障碍的复发。
Background: Although electroconvulsive therapy (ECT) has been shown to be extremely effective for the acute treatment of major depression, it has never been systematically assessed as a strategy for relapse prevention.Objective: To evaluate the comparative efficacy of continuation ECT (C-ECT) and the combination of lithium carbonate plus nortriptyline hydrochloride (C-Pharm) in the prevention of depressive relapse.Design: Multisite, randomized, parallel design, 6-month trial performed from 1997 to 2004.Setting: Five academic medical centers and their out-patient psychiatry clinics.Patients: Two hundred one patients with Structured Clinical Interview for DSM-IV-diagnosed unipolar depression who had remitted with a course of bilateral ECT.Interventions: Random assignment to 2 treatment groups receiving either C-ECT (10 treatments) or C-Pharm for 6 months.Main Outcome Measure: Relapse of depression, compared between the C-ECT and C-Pharm groups.Results: In the C-ECT group, 37.1% experienced disease relapse, 46.1% continued to have disease remission at the study end, and 16.8% dropped out of the study. In the C-Pharm group, 31.6% experienced disease relapse, 46.3% continued to have disease remission, and 22.1% dropped out of the study. Both Kaplan-Meier and Cox proportional hazards regression analyses indicated no statistically significant differences in overall survival curves and time to relapse for the groups. Mean +/- SD time to relapse for the C-ECT group was 9.1 +/- 7.0 weeks compared with 6.7 +/- 4.6 weeks for the C-Pharm group (P=.13). Both groups had relapse proportions significantly lower than a historical placebo control from a similarly designed study.Conclusions: Both C-ECT and C-Pharm were shown to be superior to a historical placebo control, but both had limited efficacy, with more than half of patients either experiencing disease relapse or dropping out of the study. Even more effective strategies for relapse prevention in mood disorders are urgently needed.