Health-Related Quality of Life in a Clinical Trial of ECT Followed by Continuation Pharmacotherapy Effects Immediately After ECT and at 24 Weeks
Health-Related Quality of Life in a Clinical Trial of ECT Followed by Continuation Pharmacotherapy Effects Immediately After ECT and at 24 Weeks
复制标题
DOI：
10.1097/yct.0b013e318205c7d7
复制
发表时间：
2011-06-01
期刊：
影响因子：
2.5
通讯作者：
Sackeim, Harold A.
中科院分区：
文献类型：
--
作者：
McCall, W. Vaughn;Rosenquist, Peter B.;Sackeim, Harold A.
目的：在一项比较去甲替林（NT）加锂（Li）和文拉法辛（VEN）加锂的临床试验中，检查电休克治疗（ECT）治疗重度抑郁症后即刻和持续药物治疗24周后健康相关生活质量（HRQOL）的决定因素。方法：在急性ECT期间，184名随机接受中等剂量双侧（BL）ECT或高剂量右侧单侧（RUL）ECT治疗的患者完成了医学结局研究简表-36（SF-36）作为ECT前和ECT后即刻的HRQOL指标。他们还被随机分配到安慰剂，NT或VEN的同时治疗。其中74例符合缓解标准，同意进一步随机分配至VEN + Li与NT + Li治疗24周以上，以预防复发，并完成最终SF-36。结果：ECT治疗前SF-36量表得分较低，反映心理健康的SF-36分量表得分尤其低。右侧单侧电极放置与ECT后即刻更好的SF-36评分相关，即使在控制抑郁改善后。ECT期间的药物分配（VEN、NT或安慰剂）与即刻HRQOL结局无关，认知表现与即刻HRQOL无关。与未缓解者相比，ECT后即刻缓解与SF-36评分显著改善相关。缓解状态仍然是ECT后24周HRQOL的一个强有力的预测因子，持续缓解者在ECT后24周HRQOL显示出额外的增益。电极放置和药物分配没有预测在24 weeks.Conclusions：使用国家的最先进的急性ECT和持续抗抑郁药物的交付，HRQOL改善ECT后显着，这种改善表现出进一步的收益与那些人谁维持缓解。在ECT后即刻，RUL组的健康相关QOL优于BL ECT组，但在24周时，HRQOL与ECT给药方式或持续抗抑郁药物治疗类型之间不存在相关性或不一致。
Objective: To examine the determinants of health-related quality of life (HRQOL) immediately after a clinical trial of electroconvulsive therapy (ECT) for major depression and then again after 24 weeks of a continuation pharmacotherapy in a clinical trial comparing nortriptyline (NT) plus lithium (Li) versus venlafaxine (VEN) plus Li.Method: During acute ECT, 184 patients randomized to treatment with moderate-dosage bilateral (BL) ECT or high-dosage right unilateral (RUL) ECT completed the Medical Outcomes Study Short Form-36 (SF-36) as a measure of HRQOL before and immediately after ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN. Seventy-four of these met remission criteria and agreed to be further randomized to 24 more weeks of VEN + Li versus NT + Li for relapse prevention and completed a final SF-36. Cognitive testing was also completed.Results: Scores from SF-36 were low before ECT, and the SF-36 subscales reflecting mental health were particularly low. Right unilateral electrode placement was associated with better SF-36 scores immediately after ECT, even after controlling for improvement in depression. Medication assignment during ECT (VEN, NT, or placebo) was not related to immediate HRQOL outcome, and cognitive performance was not related to immediate HRQOL. Remission immediately after ECT was associated with robust improvement in SF-36 scores compared with those who did not remit. Remission status remained a strong predictor of HRQOL 24 weeks after ECT, and sustained remitters showed additional gains in HRQOL 24 weeks after ECT. Electrode placement and medication assignment were not predictors at 24 weeks.Conclusions: Using state-of-the-art delivery of acute ECT and continuation antidepressant medication, HRQOL improves remarkably after ECT, and this improvement shows further gains with those persons who sustain remission. Health-related QOL is superior with RUL versus BL ECT in the immediate post-ECT period, but at 24-weeks HRQOL has absent or inconsistent relationship with mode of ECT delivery or type of continuation antidepressant pharmacotherapy.