Electroconvulsive therapy (ECT) for moderate-severity major depression among the elderly: Data from the pride study.
Electroconvulsive therapy (ECT) for moderate-severity major depression among the elderly: Data from the pride study.
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DOI：
10.1016/j.jad.2020.05.039
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发表时间：
2020-09
影响因子：
6.6
通讯作者：
S. Østergaard;M. Speed;C. Kellner;M. Mueller;S. McClintock;M. Husain;G. Petrides;W. McCall;S. Lisanby
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文献类型：
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作者：
S. Østergaard;M. Speed;C. Kellner;M. Mueller;S. McClintock;M. Husain;G. Petrides;W. McCall;S. Lisanby
背景电休克治疗（ECT）通常用于治疗重度抑郁症（MDD），但对中重度抑郁症可能同样有效。然而，这种可能性只在非常有限的范围内进行了研究。因此，我们调查ECT的疗效分层后，患者严重的抑郁症和中度严重的MDD.MethodsWe使用的数据，从延长缓解抑郁症的老年人（PRIDE）的研究，其中240例（≥60岁）与MDD的治疗与右侧单侧超短脉冲ECT，结合文拉法辛。我们使用汉密尔顿抑郁评定量表的六项核心抑郁子量表（HAM-D 6）来定义抑郁的严重程度。HAM-D 6总分≥12分为重度抑郁症，HAM-D 6总分<12分为中度抑郁症。结果重度抑郁症和中度抑郁症患者的HAM-D 6总分从基线到终点的平均变化为-8.2（95%置信区间（95%CI）= -7.5;-9.0，paired-test：p< 0.001）和-5.9（95%CI = -5.1;-6.6，paired-test：p< 0.001）。63%的重度抑郁症患者和75%的中度抑郁症患者达到缓解（HAM-D 6总分≤4）（Pearson双样本卡方检验组间差异：p= 0.27）。LimitationsThe PRIDE研究并非旨在解决此研究问题。扩大ECT的适应症以包括中度MDD患者可能是适当的。
BackgroundElectroconvulsive therapy (ECT) is usually reserved for treatment of severe major depressive disorder (MDD), but may be equally effective in the treatment of moderate-severity MDD. This possibility, however, has only been studied to a very limited extent. We therefore investigated the efficacy of ECT after stratifying patients into severe MDD and moderate-severity MDD.MethodsWe used data from the Prolonging Remission in Depressed Elderly (PRIDE) study, in which 240 patients (≥60 years) with MDD were treated with right unilateral ultrabrief pulse ECT, combined with venlafaxine. We used the six-item core depression subscale (HAM-D6) of the Hamilton Depression Rating Scale to define depression severity. Participants with baseline total scores ≥12 on the HAM-D6were considered to have severe MDD, while those with HAM-D6total scores <12 were considered to have moderate-severity MDD.ResultsAmong the participants with severe MDD and moderate-severity MDD, the mean change in the HAM-D6total score from baseline to endpoint was -8.2 (95% confidence interval (95%CI) = -7.5; -9.0, pairedt-test:p< 0.001) and -5.9 (95%CI = -5.1; -6.6, pairedt-test:p< 0.001), respectively. A total of 63% of those with severe MDD and 75% of those with moderate-severity MDD achieved remission (HAM-D6total score ≤4) (Pearson's 2-sample chi-squared test of difference between groups:p= 0.27).LimitationsThe PRIDE study was not designed to address this research question.ConclusionsECT combined with venlafaxine appears to be an effective treatment for moderate-severity MDD. It may be appropriate to expand the indications for ECT to include patients with moderate-severity MDD.