ECT: OPTIMUM SCHEDULE AND ANTIDEPRESSANT MECHANISMS

ECT：最佳时间表和抗抑郁机制

• 批准号: 3379077
• 负责人: BERNARD LERER
• 金额: $ 5.63万
• 依托单位: HERZOG HOSPITAL-EZRATH NASHIM
• 依托单位国家: 美国
• 财政年份: 1986
• 资助国家: 美国
• 起止时间: 1986-09-01 至 1990-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3379077
• 关键词: antidepressants; cognition; convulsions; electroconvulsive therapy; fenfluramine; human subject; human therapy evaluation; memory disorders; neurochemistry; neuroendocrine system; neuropsychological tests

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.

尽管电休克疗法 (ECT) 是一种高效且广泛应用的治疗方法，但 用于治疗严重抑郁症，最佳给药方案 从来没有被明确地确定过。 现有证据有力 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 ECT 诱发记忆的严重程度 损伤已被证明与频率和频率累积相关 治疗次数。 两个参数都减少了一倍 因此，如果每周时间表允许的话，这是非常可取的 可以明确地证明治疗效果未受影响。 这 因此，目前的协议要求随机分配、双盲 比较，通过使用模拟 ECT 控制两次和三次之间的比较 每周 ECT 给药时间安排。 临床反应和 在 4 周的急性治疗期间将连续评估认知功能 6个月持续治疗期间的周期和长期影响 碳酸锂。 该提案的基本假设是抗抑郁药 ECT 的作用是时间依赖性的，并且不会通过增加 治疗施用频率超出最佳水平。 生物 与抗抑郁机制相关的作用应由 临床上有效的最不频繁的时间表。 两个潜在的 将在这方面研究重要参数： (1) 临床前研究强烈暗示中枢血清素能 抗抑郁治疗作用机制的影响包括 等。 在本方案中，血浆催乳素对 芬氟拉明将用作中枢血清素变化的标记物 ECT 诱导的功能。 (2) 最近的神经生理学理论表明，通过 ECT 进行诱导， 中枢代谢低下状态可能是其抗抑郁作用的基础。 在本议定书中，癫痫发作阈值增加，推测 反映 ECT 引起的神经代谢低下状态，将连续进行 治疗过程中进行监测。 每周两次和三次 ECT 对这两个参数的影响 将与治疗结果进行比较和关联。 调查结果 因此，该项目可能会对 ECT 的作用机制以及其对健康的潜在影响 临床实践。