CONTINUATION OF PHARMACOTHERAPY FOLLOWING ECT

描述（改编自申请人摘要）：申请人认为 ECT非常有效，并指出接受ECT的患者 抑郁症的形式往往与严重的形式。 早期复发 可能是ECT使用中最关键的临床问题。 在 单极患者，目前的标准是使用持续单药治疗 与杂环（HCA）或其他抗抑郁药联合使用，以预防复发 ECT之后。 这一做法主要是基于1999年进行的三项研究。 1960年代的英国 除了方法上的缺陷， 目前的做法值得怀疑。 电休克疗法经常是“第一次”， 选择”治疗，以及适当药物治疗的标准已经改变 相当大。 对抗抑郁药充分试验的抵抗现在是 ECT的主要适应症，以及同类抗抑郁药物 在急性发作期间失败的患者通常被用作 ECT后继续治疗。 这种做法的有效性从来没有 得到证实。 在早期的自然主义研究中，这些研究人员 发现一次治疗失败的患者复发率是另一次的两倍 或更充分的ECT前HCA试验，与接受ECT的患者相比， 没有充分的药物试验 ECT后的准确性 药物治疗与复发仅轻微相关。 在相关 研究人员还表示，药物耐药性 是ECT短期疗效的有力预测指标。 使用R10机制， 三个申请人建议完成一项多中心研究， 重新评估ECT应答者的持续药物治疗。 这项研究将 在纽约州立精神病研究所进行; 爱荷华州;西部精神病研究所和诊所。 一个平行组， 采用随机分配、双盲试验设计， 安慰剂、去甲替林和去甲替林-锂联合治疗的疗效 碳酸盐治疗在预防原发性ECT应答后复发中的作用 单极患者。 最初假设去甲替林 单独使用对许多患者的益处有限， 与锂结合。 中期数据记录了非常高的复发率 安慰剂和去甲替林的发生率以及 联合治疗 此外，前瞻性地使用了更大的样本 评价了临床特征和治疗史， ECT管理的标准化。 这个假设是 药物抵抗是ECT疗效的一个有效预测因素， 当被考虑时，它负责更好的明显联系， 伴有精神病的抑郁症患者的ECT反应 申请人声称， 这项研究应该对ECT何时 在急性抑郁发作的治疗过程中， 关键是，在建立有效的药理学策略， 预防复发

DESCRIPTION (adapted from applicant's abstract): The applicants contend that ECT is highly effective and note that patients that receive this modality often present with severe forms of major depression. Early relapse is perhaps the most critical clinical problem in the use of ECT. In unipolar patients, the current standard is to use continuation monotherapy with a heterocyclic (HCA) or other antidepressant for relapse prevention following ECT. This practice is largely based on three studies conducted in England in the 1960's. Besides methodological flaws, the relevance of this work to present practice is questionable. ECT was frequently a "first choice" treatment, and standards for adequate pharmacotherapy have changed considerably. Resistance to adequate trials of antidepressants is now the primary indication for ECT, and the same class of antidepressant medication that patients failed during the acute episode is commonly used as continuation therapy following ECT. The efficacy of this practice has never been substantiated. In an earlier naturalistic study, these investigators found that the relapse rate was twice as high in patients who had failed one or more adequate pre-ECT HCA trials, compared to patients who came to ECT without any adequate medication trials. Adequacy of post-ECT pharmacotherapy was only marginally related to relapse. In related research, the investigators have also suggested that medication resistance is a strong predictor of ECT short-term outcome. Using the R10 mechanism, the three applicants propose to complete a multi-center study that re-evaluates continuation pharmacotherapy in ECT responders. The study will be conducted at the New York State Psychiatric Institute; the University of Iowa; and Western Psychiatric Institute and Clinic. A parallel group, random assignment, double-blind design is used to test the relative efficacies of placebo, nortriptyline, and combination nortriptyline-lithium carbonate treatments in preventing relapse following ECT response in primary unipolar patients. It was hypothesized at the outset that nortriptyline alone was of limited benefit for many patients and less effective than its combination with lithium. The interim data document remarkably high relapse rates both with placebo and nortriptyline and substantial efficacy for the combination treatment. In addition, a larger sample is prospectively evaluated regarding clinical features and treatment history, with standardization of ECT administration across sites. The hypothesis is tested that medication resistance is a potent predictor of ECT efficacy, and, when considered, is responsible for the apparent association of better ECT response in depressed patients with psychosis. The applicants assert that this study should have important implications for when ECT is considered during the treatment of the acute depressive episode and, most critically, in establishing an efficacious pharmacological strategy for relapse prevention.