Effect of Concomitant Pharmacotherapy on Electroconvulsive Therapy Outcomes Short-term Efficacy and Adverse Effects
Effect of Concomitant Pharmacotherapy on Electroconvulsive Therapy Outcomes Short-term Efficacy and Adverse Effects
复制标题
DOI：
10.1001/archgenpsychiatry.2009.75
复制
发表时间：
2009-07-01
影响因子：
--
通讯作者：
Haskett, Roger F.
中科院分区：
文献类型：
--
作者：
Sackeim, Harold A.;Dillingham, Elaine M.;Haskett, Roger F.
背景：药物抵抗是重度抑郁症患者使用电休克治疗（ECT）的主要适应症。在ECT之前停止抗抑郁药物的做法来自20世纪60年代和70年代对非耐药样本的研究。关于右侧单侧和双侧ECT的相对疗效和不良反应也存在持续的争议。目的：为了检验与安慰剂相比，在ECT过程中伴随使用去甲曲普林或文拉法辛治疗可增强短期疗效而对不良反应无有意义的影响并降低ECT后复发率的假设，并检验高剂量、右侧、单侧ECT的疗效与中等剂量双侧ECT相当，并且在认知副作用方面保留了优势。设计：前瞻性、随机、三盲、安慰剂对照研究，从2001年到2005年进行。设置：三所大学医院。患者：在约750名连续的ECT患者中，有319名重度抑郁发作的患者同意接受ECT治疗，并被随机分配到药物或ECT治疗条件下，并接受至少一次ECT治疗。评分的汉密尔顿评定量表抑郁症，缓解率完成后的ECT，和选择性措施的认知不良反应。结果：治疗与去甲替林增强疗效和减少认知不良反应的ECT相对于安慰剂。文拉法辛的改善程度较弱，并有加重认知不良反应的趋势。高剂量的右侧单侧ECT没有不同或上级双边ECT的疗效，并导致较轻的amnesia.Conclusions：ECT的疗效大幅增加，除了抗抑郁药物，但这些药物可能会有所不同，无论是减少或增加认知不良反应。高剂量、右侧、单侧ECT的疗效至少与中等剂量双侧ECT相当，但在认知不良反应方面仍具有优势。
Context: Medication resistance is the leading indication for use of electroconvulsive therapy (ECT) in major depression. The practice of stopping antidepressant medications prior to ECT derived from studies in the 1960s and 1970s in nonresistant samples. There is also continuing controversy regarding the relative efficacy and adverse effects of right unilateral and bilateral ECT.Objective: To test the hypotheses that, compared with placebo, concomitant treatment with nortriptline or venlafaxine during the ECT course enhances short-term efficacy without a meaningful effect on adverse effects and reduces the rate of post-ECT relapse, and to test the hypotheses that high-dose, right-sided, unilateral ECT is equivalent in efficacy to moderate-dosage bilateral ECT and retains advantages with respect to cognitive adverse effects.Design: Prospective, randomized, triple-masked, placebocontrolled study conducted from 2001 through 2005.Setting: Three university-based hospitals.Patients: Of approximately 750 consecutive patients referred for ECT, 319 with a major depressive episode consented, were randomized to pharmacological or ECT treatment conditions, and received at least 1 ECT treatment.Main Outcome Measures: Scores on the Hamilton Rating Scale for Depression, remission rate following completion of ECT, and selective measures of cognitive adverse effects.Results: Treatment with nortriptyline enhanced the efficacy and reduced the cognitive adverse effects of ECT relative to placebo. Venlafaxine resulted in a weaker degree of improvement and tended to worsen cognitive adverse effects. High-dosage right unilateral ECT did not differ or was superior to bilateral ECT in efficacy and resulted in less severe amnesia.Conclusions: The efficacy of ECT is substantially increased by the addition of an antidepressant medication, but such medications may differ in whether they reduce or increase cognitive adverse effects. High-dose, right-sided, unilateral ECT is at least equivalent to moderate-dosage bilateral ECT in efficacy, but retains advantages with respect to cognitive adverse effects.