ECT: OPTIMUM SCHEDULE AND ANTIDEPRESSANT MECHANISMS

虽然电休克治疗(ECT)是一种高效和广泛的治疗方法 用于治疗严重抑郁症的最佳给药方案 从来没有被确定过。有确凿的证据 建议每周两次治疗是有效的；但更频繁 涉及更多ECT的时间表，在许多情况下继续使用 中心，特别是在美国。ECT诱发记忆的严重性 损伤已被证明与频率和 治疗次数。两个参数的减少是两次 因此，在以下情况下，非常可取的是每周时间表许可 治疗的益处可以明确地证明是不受损害的。这个 因此，本协议要求随机分配，双盲 两次和三次模拟ECT的对照研究 每周一次的ECT治疗计划。临床反应和 在四周的急性治疗期间，将对认知功能进行连续评估 维拉帕米持续治疗6个月的周期和远期疗效 碳酸锂。 这项提议的基本假设是，抗抑郁剂 ECT的作用是依赖于时间的，并且不会通过增加 超过最佳水平的治疗给药频率。生物学 与抗抑郁机制相关的效应应由 临床有效的最低频次计划。两个潜在的 将在此背景下研究重要参数： (1)临床前研究强烈表明中枢5-羟色胺能 抗抑郁治疗的作用机制包括 ECT。在本方案中，血浆催乳素对 芬氟拉明将被用作中枢5-羟色胺能变化的标志 电刺激诱发的功能。 (2)最近的一项神经生理学理论表明，通过ECT诱导， 处于中枢低代谢状态，可能是其抗抑郁作用的基础。 在本方案中，癫痫发作阈值增加，推测 反映ECT诱导的神经低代谢状态，将是连续的 在治疗过程中进行监测。 每周两次和三次电刺激对上述两项指标的影响 将与治疗方案进行比较和关联。调查结果： 因此，这一项目可能会对 电休克治疗的作用机制及其潜在影响 临床实践。

Although electroconvulsive therapy (ECT) is a highly effective and widely used treatment for severe depression, an optimum schedule of administration has never been definitively established. Available evidence strongly suggests that twice weekly treatments are effective; yet more frequent schedules involving a greater number of ECT's, continue to be used in many centers, particularly in the U.S.A. Severity of ECT-induced memory impairment has been shown to be cumulatively related to frequency and number of treatments. The reduction in both parameters which a twice weekly schedule permits, is therefore highly desirable provided that therapeutic benefit can be definitively shown to be unimpaired. The present protocol therefore calls for a random assignment, double-blind comparison, controlled by the use of simulated ECT between twice and three times weekly schedules of ECT administration. Clinical response and cognitive function will be serially rated during the 4 week acute treatment period and long-term effects during 6 month continuation therapy with lithium carbonate. The underlying hypothesis of this proposal is that the antidepressant action of ECT is time dependent, and is not accelerated by increasing the frequency of treatment administration beyond an optimum level. Biological effects relevant to antidepressant mechanisms should be induced by the least frequent schedule which is clinically effective. Two potentially important parameters will be studied in this context: (1) Preclinical studies have strongly implicated central serotonergic effects in the mechanism of action of antidepressant treatments including ECT. In the present protocol, the plasma prolactin response to fenfluramine will be used as a marker for changes in central serotonergic function induced by ECT. (2) A recent neurophysiological theory suggests that the induction, by ECT, of a central hypometabolic state, may underlie its antidepressant action. in the present protocol, seizure threshold increases which putatively reflect the ECT-induced neural hypometabolic state, will be serially monitored during the treatment course. The effects of twice and three times weekly ECT on both these parameters will be compared and correlated with treatment outome. The findings of this project are therefore likely to have important implications for the mechanism of action of ECT in addition to their potential impact on clinical practice.