ECT: OPTIMUM SCHEDULE AND ANTIDEPRESSANT MECHANISMS

虽然电休克治疗（ECT）是一种高效和广泛的 用于治疗严重抑郁症，一个最佳的管理时间表 从来没有被确定过。 现有证据有力地证明 表明每周两次治疗是有效的;但更频繁 涉及更多ECT的时间表，继续在许多国家使用， 中心，特别是在美国。 已经证明损伤与频率累积相关， 治疗次数。 这两个参数的减少， 因此，非常希望每周的时间表允许，只要 可以明确地显示治疗益处未受损害。 的 因此，本方案要求随机分配、双盲 比较，通过使用两次和三次之间的模拟ECT进行控制 时间表每周ECT管理。 临床应答和 认知功能将在4周急性治疗期间连续评定 6个月持续治疗期间的阶段和长期影响， 碳酸锂 这一提议的基本假设是， ECT的作用是时间依赖性的，并且不会通过增加 给药频率超过最佳水平。 生物 与抗抑郁机制相关的作用应该由 最低频率的时间表是临床有效的。 两个潜在 将在这方面研究重要的参数： (1)临床前研究强烈暗示中枢神经系统的多巴胺能神经元 抗抑郁治疗作用机制的影响，包括 等方面 在本方案中，血浆催乳素对 芬氟拉明将被用作中枢多巴胺能神经系统变化的标志物。 ECT诱导的功能。 (2)最近的一项神经生理学理论表明，ECT的诱导作用， 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， 反映ECT诱导的神经低代谢状态，将连续 在治疗过程中进行监测。 每周两次和三次ECT对这些参数的影响 将与治疗结果进行比较和关联。 的调查结果 因此，该项目可能会对 ECT的作用机制，以及它们对 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.