ECT: OPTIMUM SCHEDULE AND ANTIDEPRESSANT MECHANISMS

描述(改编自申请人摘要)：尽管 电休克治疗(ECT)被认为是非常有效的，并且 广泛用于重度抑郁症的治疗，是一种最佳选择 治疗时间表从来没有确定下来。临床 在给药频率方面，实践继续存在很大差异。 以及该系列中的ECT数量。本项目的中期成果 确认这些参数可以在很大程度上影响 抗抑郁反应和认知不良反应。相比之下，两次 每周治疗(ECTx2)，每周接受ECTx3的患者有反应 明显更快，但也更受损害 四周试验结束时的神经心理测试(尽管不是 在1个月和6个月的随访中)。 该项目的下一阶段将重点优化更多 通过减少ECT的数量实现快速有效的ECTx3计划 对这组人进行管理。这一战略是合理的，因为之前的 这一发现有望显著降低认知发病率 不改变应答率或最终结果。双盲 与ECTx2的比较将通过使用模拟ECT和 将根据实数(n=8)和模拟数来平衡分组 (n=4)在研究的4周急性期给予的治疗。 在6个月的跟踪期间，将再次评估长期效果 碳酸锂持续治疗。 该项目的一个中心目标是将生物效应 使用最佳有效治疗的ECT。下一阶段的研究 将进一步表征ECT的显著增强 5-羟色胺介导的激素释放 演示了。这种影响的时间进程和长期状态将是 经检查并确定的特定神经化学成分 介绍一种额外的药物-内分泌(芬氟拉明或 爱普沙龙)挑战范式。

DESCRIPTION (Adapted from Applicant's Abstract): Although electroconvulsive therapy (ECT) is recognized to be highly effective and is extensively used in the management of severe depression, an optimum treatment schedule has never been definitively established. Clinical practice continues to vary widely in terms of frequency of administration and number of ECTs in the series. Interim results from the present project confirm that these parameters can substantially influence both rate of antidepressant response and cognitive adverse effects. Compared to twice weekly treatment (ECTx2), patients who received ECTx3 per week responded significantly more rapidly but were also more impaired on neuropsychological testing at the end of the four week trial (although not at 1 and 6 month follow-up). The next stage of the project will focus on optimization of the more rapidly effective ECTx3 schedule by reducing the number of ECT's administered to this group. This strategy is justified by the previous findings and is expected to significantly diminish cognitive morbidity without altering rate of response or final outcome. Double-blind comparison with ECTx2 will be achieved by the use of simulated ECT and the groups will be balanced in terms of number of real (n=8) and simulated (n=4) treatments administered during the 4 week acute phase of the study. Long term effects will again be assessed during 6 month follow-up under lithium carbonate continuation therapy. A central objective of the project has been to correlate biological effects of ECT with optimally effective treatment. The next phase of the study will further characterize the significant enhancement by ECT of serotonergically mediated hormone release which was previously demonstrated. The time course and long term status of this effect will be examined and specific neurochemical components identified by the introduction of an additional pharmaco-endocrine (fenfluramine or ipsapirone) challenge paradigm.