Prudic J, Sackeim H A
Department of Biological Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, 10032, USA.
J Clin Psychiatry. 1999;60 Suppl 2:104-10; discussion 111-6.
For major psychiatric disorders in which suicidality is often a symptom, electroconvulsive therapy (ECT) is an established, highly effective treatment. In fact, suicidal risk may be an indication for the use of ECT to treat those disorders. The authors present new data and review clinical experience that indicate that ECT often exerts a profound short-term beneficial effect on suicidality. Little, if any, evidence supports a long-term positive effect of ECT on suicide rates, especially if diagnostically heterogeneous groups are considered. However, patients may have been assigned ECT precisely because they were suicidal and, hence, these reports may represent underestimates. As a whole, the published reports are weakened by methodological shortcomings, such as lack of controls, weak design, and possible cohort effects. In fact, most studies were designed to examine the impact of ECT on mortality rates in general, and all but one study found reductions in overall mortality, the source of which remains undetermined.
对于自杀倾向常常作为症状之一的重度精神疾病，电休克疗法（ECT）是一种既定的、高效的治疗方法。事实上，自杀风险可能是使用ECT治疗这些疾病的一个指征。作者展示了新的数据并回顾了临床经验，这些表明ECT常常对自杀倾向产生深远的短期有益影响。几乎没有证据支持ECT对自杀率有长期的积极影响，尤其是考虑到诊断上异质性的群体时。然而，患者可能恰恰因为有自杀倾向而被安排接受ECT治疗，因此，这些报告可能低估了ECT的效果。总体而言，已发表的报告因方法学上的缺陷而受到削弱，比如缺乏对照、设计薄弱以及可能存在的队列效应。实际上，大多数研究旨在检验ECT对总体死亡率的影响，除一项研究外，所有研究均发现总体死亡率有所降低，但其原因尚不明晰。
