Onset and time course of antidepressant action: psychopharmacological implications of a controlled trial of electroconvulsive therapy.
Onset and time course of antidepressant action: psychopharmacological implications of a controlled trial of electroconvulsive therapy.
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抗抑郁作用的起效和时程：电惊厥治疗对照试验的精神药理学意义。
DOI：
10.1007/bf02245860
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发表时间：
1995
影响因子：
3.4
通讯作者：
Lerer,B
中科院分区：
文献类型：
--
作者：
Segman,RH;Shapira,B;Gorfine,M;Lerer,B
研究人员对 47 名重度抑郁症患者的抗抑郁作用起效和时程进行了检查，这些患者被随机分配至每周两次双侧短暂脉冲电惊厥治疗加每周一次模拟治疗 (ECT×2) 或每周 3 次给药方案 (ECT×3)。在ECT×3组中观察到了快速改善，其中汉密尔顿抑郁量表（HAM-D）的实际ECT数量减少了30%，在7.3±4.43天内减少了3.2±1.90，在13.7±7.21天内减少了60%，实际ECT数量为5.9±3.09。在两组的反应者中，HAM-D 整体改善的 24.3±29.58% 是由第一次真正的 ECT 贡献的，60.9±28.13% 是由前四次真正的 ECT 贡献的，91.6±25.82% 是由前八次真正的 ECT 贡献的。尽管 85.3% 的应答者在 8 次 ECT 后达到了 60% HAM-D 改善，但临床上显着的少数 (14.7%) 在疗程后期才出现应答 (ECT 9-12)。然而，根据第六次真实 ECT 的症状改善（HAM-D 为 30%），反应是可以预测的。根据此标准，34 名应答者中有 33 名被正确识别，而 13 名非应答者中只有 2 名被错误识别（P<0.000001）。一旦达到抗抑郁效果，无需继续药物治疗，直至最后一次治疗后 1 周，并继续使用碳酸锂 (Li) 或 Li 加氯米帕明 3 周。这些发现证实了临床印象，即 ECT 是治疗重度抑郁症的一种快速有效的治疗方法，其潜伏期比一般报道的抗抑郁药物更短。阐明其神经生物学机制可能有助于开发具有相似特征的药物。
Onset and time course of antidepressant effect were examined in 47 patients with major depressive disorder who had been randomly assigned to twice weekly bilateral, brief pulse electroconvulsive therapy plus one simulated treatment per week (ECT×2) or to a three times weekly schedule of administration (ECT×3). Rapid improvement was observed in the ECT×3 group in whom the number of real ECTs to 30% reduction on the Hamilton Depression Scale (HAM-D) was 3.2±1.90, administered over 7.3±4.43 days and to 60% reduction, 5.9±3.09 real ECTs over 13.7±7.21 days. Among the responders in both groups combined, 24.3±29.58% of the overall improvement in HAM-D was contributed by the first real ECT, 60.9±28.13% by the first four real ECTs and 91.6±25.82% by the first eight. Although 85.3% of the responders had reached 60% HAM-D improvement after eight ECTs, a clinically significant minority (14.7%) responded later in the course (ECT 9–12). However, response was predictable on the basis of symptomatic improvement (30% on the HAM-D) by the sixth real ECT. Thirty-three out of 34 responders would have been correctly identified by this criterion and only 2 out of 13 non-responders mis-identified (P<0.000001). Once achieved, the antidepressant effect was stable, without continuation pharmacotherapy, until 1 week after the last treatment and on lithium carbonate (Li) or Li plus clomipramine for a further 3 weeks. These findings confirm the clinical impression that ECT is a rapidly effective treatment for major depression with a shorter latency than generally reported for antidepressant drugs. Elucidation of its neurobiological mechanisms could contribute to the development of pharmacological agents with a similar profile.