Response of Depression to Electroconvulsive Therapy: A Meta-Analysis of Clinical Predictors
Response of Depression to Electroconvulsive Therapy: A Meta-Analysis of Clinical Predictors
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DOI：
10.4088/jcp.14r09528
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发表时间：
2015-10-01
影响因子：
5.3
通讯作者：
Mickey, Brian J.
中科院分区：
文献类型：
--
作者：
Haq, Aazaz U.;Sitzmann, Adam F.;Mickey, Brian J.
目的：大约三分之一的抑郁症患者对电休克治疗 (ECT) 没有反应。 ECT 反应的可靠预测因子将有助于患者选择，但尚未得到明确证明。我们使用荟萃分析来测量抑郁症中 ECT 反应的一系列临床预测因子的效应大小。数据来源：系统地检索了 PubMed，以识别 1980 年之后发表的研究，这些研究测试了至少 1 个 ECT 反应的临床预测因子。研究选择：在确定的 51 项研究中，有 32 项与荟萃分析相一致。数据提取：针对 10 个临床预测因子中的每一个计算加权平均比值比 (OR) 或标准化平均差 (SMD)，基于二分结果（有反应者与无反应者）。统计分析检查了稳健性、偏倚和异质性。结果：抑郁发作持续时间越短，ECT 缓解率越高（SMD = -0.37，7 项研究，702 名受试者，P = 4 x 10(-6)）。当前事件中的药物失败史也是一个强有力的预测因素：对于有或没有药物失败的患者，缓解率分别为 58% 和 70%（OR = 0.56，11 项研究，1,175 名受试者，P = 1 x 10(-5)）。较大的年龄和精神病特征与较高的 ECT 反应率关联较弱，但异质性值得注意。双相情感障碍诊断、性别、发病年龄和既往发作次数并不是显着的预测因素。由于研究异质性，对症状严重程度和忧郁特征的分析尚无定论。结论：基线时较长的抑郁发作和药物治疗失败是 ECT 反应不佳的有力预测因素，其效应大小虽不大，但具有临床相关性。传统上使用的患者特征，例如年龄、精神病和忧郁特征，在临床上不太可能有用。需要更强大的临床和生物学预测因子来管理考虑 ECT 的抑郁症患者。
Objective: Roughly one-third of individuals with depression do not respond to electroconvulsive therapy (ECT). Reliable predictors of ECT response would be useful for patient selection, but have not been demonstrated definitively. We used meta-analysis to measure effect sizes for a series of clinical predictors of ECT response in depression.Data Sources: PubMed was searched systematically to identify studies published after 1980 that tested at least 1 clinical predictor of response to ECT.Study Selection: Of 51 studies identified, 32 were compatible with meta-analysis.Data Extraction: The weighted mean odds ratio (OR) or standardized mean difference (SMD) was computed for each of 10 clinical predictors, based on dichotomous outcomes (responder vs nonresponder). Statistical analyses examined robustness, bias, and heterogeneity.Results: Shorter depressive episode duration predicted higher ECT response rate (SMD = -0.37, 7 studies, 702 subjects, P = 4 x 10(-6)). History of medication failure in the current episode was also a robust predictor: response rates were 58% and 70%, respectively, for those with and without medication failure (OR = 0.56, 11 studies, 1,175 subjects, P = 1 x 10(-5)). Greater age and psychotic features were weakly associated with higher ECT response rates, but heterogeneity was notable. Bipolar diagnosis, sex, age at onset, and number of previous episodes were not significant predictors. Analyses of symptom severity and melancholic features were inconclusive due to study heterogeneity.Conclusions: Longer depressive episodes and medication failure at baseline are robust predictors of poor response to ECT, with effect sizes that are modest but clinically relevant. Patient characteristics used traditionally such as age, psychosis, and melancholic features are less likely to be clinically useful. More robust clinical and biological predictors are needed for management of depressed patients considering ECT.