Relapse during continuation pharmacotherapy after acute response to ECT: a comparison of usual care versus protocolized treatment.
Relapse during continuation pharmacotherapy after acute response to ECT: a comparison of usual care versus protocolized treatment.
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ECT 急性反应后继续药物治疗期间复发：常规护理与方案治疗的比较。
DOI：
10.1080/10401230601163360
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Sackeim,HaroldA
中科院分区：
文献类型：
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作者：
TewJr,JamesD;Mulsant,BenoitH;Haskett,RogerF;Joan,Prudic;Begley,AmyE;Sackeim,HaroldA
背景：电休克疗法是治疗抑郁症的一种有效方法，但复发率较高。在急性治疗期的所有应答者中，约有一半在继续治疗期间复发。最近的文献指出，与“常规护理”相比，入组研究方案的患者结局存在“疗效-有效性差距”。本研究比较了常规护理与常规药物治疗在预防ECT.Methods后复发方面的有效性。73例患者随机接受持续药物治疗，包括去甲替林、去甲替林加锂或安慰剂。53例患者拒绝参加随机试验自然6个月或直到抑郁症复发在usual care settings.Results.All，但一个“常规护理”的患者接受药物治疗后ECT; 27（51%）6个月内复发。只有一个普通护理患者接受持续ECT作为一线治疗。“常规治疗”的复发率是中间的复发率的患者接受协议去甲替林（60%）和去甲替林加锂（39%），但上级安慰剂（84%）。这表明ECT后的高复发率不仅仅是由于“疗效-效果差距”。
Background.ECT, an effective treatment for major depression, is associated with a high relapse rate. Roughly half of all responders during the acute treatment phase relapse during continuation treatment. Recent literature has pointed out an “efficacy-effectiveness gap” in outcomes of patients enrolled in study protocols when compared to “care as usual.” This study compares the effectiveness of usual care versus protocolized pharmacotherapy in preventing relapse following ECT.Methods.One hundred twenty-six depressed patients responded to acute ECT. Seventy-three were randomized to continuation pharmacotherapy consisting of nortriptyline, nortriptyline-plus-lithium, or placebo. The 53 patients that refused to participate in the randomized trial were followed naturalistically for 6 months or until depression relapse in usual care settings.Results.All but one “usual care” patient received pharmacotherapy following ECT; 27 (51%) relapsed within 6 months. Only one usual care patient received continuation ECT as a first-line treatment. The “usual care” relapse rate was intermediate to the relapse rates of the patients receiving protocolized nortriptyline (60%) and nortriptyline-plus-lithium (39%), but superior to placebo (84%).Conclusions.The relapse rate associated with usual care following ECT was comparable to that of protocolized pharmacotherapy. This suggests that high relapse rates following ECT are not due solely to an “efficacy-effectiveness gap.”