EFFICACY AND LONG-TERM CLINICAL OUTCOME OF COMORBID POSTTRAUMATIC STRESS DISORDER AND MAJOR DEPRESSIVE DISORDER AFTER ELECTROCONVULSIVE THERAPY
EFFICACY AND LONG-TERM CLINICAL OUTCOME OF COMORBID POSTTRAUMATIC STRESS DISORDER AND MAJOR DEPRESSIVE DISORDER AFTER ELECTROCONVULSIVE THERAPY
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DOI：
10.1002/da.22451
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发表时间：
2016-07-01
影响因子：
7.4
通讯作者：
Atre-Vaidya, Nutan
中科院分区：
文献类型：
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作者：
Ahmadi, Naser;Moss, Lori;Atre-Vaidya, Nutan
背景：许多患者同时符合创伤后应激障碍（PTSD）和重性抑郁障碍（MDD）的标准。电休克治疗（ECT）是公认的难治性MDD最有效的治疗方法。本研究探讨ECT对PTSD和MDD共病患者长期临床结局的疗效。研究方法：这项回顾性巢式匹配病例对照研究纳入了22，164例受试者[3，485例MDD和PTSD共病（92例接受ECT治疗，3，393例未接受ECT治疗），18，679例无MDD和PTSD]。结果如下：使用临床总体印象量表（CGI）评估疗效，与单独抗抑郁药治疗（50%）相比，ECT（90%）观察到PTSD和MDD症状的更稳健改善（P = 0.001）。中位随访8年，无PTSD和MDD组死亡率为8%，ECT治疗组死亡率为9.7%，无ECT治疗组死亡率为18%（P < 0.05）。经ECT治疗后PTSD和MDD的自杀率分别为2.2%和5.9%（P < 0.05）。生存分析显示，与无PTSD和MDD的匹配队列相比，患有MDD和PTSD的患者接受ECT治疗的心血管和全因死亡率的相对风险无显著差异（P > 0.05）。与未接受ECT治疗的患者相比，接受ECT治疗的MDD和PTSD患者自杀、全因死亡和心血管死亡的相对风险分别降低了64%、65%和46%（P < 0.05）。结论：ECT与显著减少PTSD和MDD的症状，以及降低MDD和PTSD中自杀、心血管和全因死亡率的风险相关，其效果比单独抗抑郁药治疗更稳健。(C)2015年威利期刊公司
Background: Many patients fulfill criteria for both posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Electroconvulsive therapy (ECT) is generally acknowledged to be the most-effective treatment for refractory MDD. This study investigated the efficacy of ECT on long-term clinical outcome of comorbid PTSD and MDD. Methods: This retrospective nested matched case-control study is inclusive of 22,164 subjects [3,485 with comorbid MDD and PTSD (92 with ECT and 3,393 without ECT) and 18,679 without MDD and PTSD]. Results: Using the clinical global impression scale (CGI) to assess efficacy, more-robust improvement of PTSD and MDD symptoms was observed with ECT (90%), compared to antidepressant-treatment alone(50%) (P = 0.001). During the median of 8 years of follow-up, the death-rate was 8% in subjects without PTSD and MDD, 9.7% in PTSD and MDD treated with ECT and 18% in PTSD andMDDwithout ECT (P < 0.05). The suicide-rate was 2.2 and 5.9% in PTSD and MDD with and without ECT-treatment, respectively (P < 0.05). Survival-analyses revealed that the relative-risk of cardiovascular and all-cause mortality is not significantly different in patients with comorbid MDD and PTSD treated with ECT, compared to a matched-cohort without PTSD and MDD (P > 0.05). The relative risk of suicidality, all-cause, and cardiovascular mortality was reduced 64, 65, and 46% in MDD and PTSD patients treated with ECT, compared to those without ECT (P < 0.05). Conclusion: ECT is associated with a significant reduction of symptoms of PTSD and MDD, as well as reduction in risk of suicidality, cardiovascular, and all-cause mortality in MDD and PTSD, an effect more robust than antidepressant-therapy alone. (C) 2015 Wiley Periodicals, Inc.