CONTINUATION PHARMACOTHERAPY FOLLOWING ECT

ECT非常有效，接受这种治疗的患者经常 出现严重形式的严重抑郁症。早期复发可能是 ECT使用中最关键的临床问题。单极 患者，目前的标准是使用持续的单一治疗 用于预防复发的杂环(HCA)或其他抗抑郁药 在电击治疗后。这种做法在很大程度上是基于三项研究 S。除了方法论上的缺陷， 这项工作以目前的做法是值得怀疑的。ECT经常是一种 “首选”治疗和适当药物治疗的标准 变化很大。对足够的抗抑郁药物试验的耐药性 现在是ECT的主要适应症，并且是同一类别的 患者在急性发作期间服用的抗抑郁药物失败 通常用于ECT后的继续治疗。的功效。 这种做法从未得到证实。在早期的自然主义中 研究发现，符合以下条件的患者的复发率是前者的两倍 与患者相比，有一项或多项充分的ECT前HCA试验失败 在没有进行任何适当的药物试验的情况下来接受电击治疗。充分性 ECT后药物治疗与复发的关系不大。在……里面 相关研究，我们也曾提出，药物耐药性是 是ECT短期结果的有力预测指标。使用R10机制， 我们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。这项研究是进行的 在爱荷华大学纽约州精神病研究所，以及 西方精神病学研究所和诊所。一组平行的、随机的 采用配对、双盲设计进行相对有效性检验 安慰剂、去甲替林及去甲替林锂联合用药 碳酸盐疗法在预防ECT反应后复发中的作用 原发单相患者。一开始就假设 去甲替林单独对许多患者和更少的患者益处有限 比它与锂的结合更有效。临时数据文件 服用安慰剂和去甲替林组的复发率都非常高， 综合治疗效果显着。此外，一个更大的 对样本进行前瞻性评估以了解其临床特征和 治疗历史，电休克治疗的标准化管理 网站。这一假设得到了检验，即药物耐药性是一种强有力的 ECT疗效的预测因子，当考虑到时，它负责 抑郁症患者较好的ECT反应明显相关 精神错乱。这项研究应该对ECT何时成为 在治疗急性抑郁发作时考虑，大多数 关键的是，在建立一种有效的药物治疗策略 预防复发。

ECT is highly effective and 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, we found that the relapse rate was twice as high in patients who had failed one or more adequate preECT HCA trials, compared to patients who came to ECT without any adequate medication trials. Adequacy of postECT pharmacotherapy was only marginally related to relapse. In related research, we have also suggested that medication resistance is a strong predictor of ECT short-term outcome. Using the R10 mechanism, we propose to complete a multi-center study that re-evaluates continuation pharmacotherapy in ECT responders. The study is conducted at the New York State Psychiatric Institute, 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. 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.