Roose S P, Nobler M
Department of Clinical Psychiatry, New York State Psychiatric Institute, NY 10032, USA.
J Clin Psychiatry. 2001;62 Suppl 4:24-6; discussion 37-40.
Although there is a long-standing clinical belief that electroconvulsive therapy (ECT) is the fastest available treatment for depression, ECT has not been compared directly with drug therapy. For this reason, it is impossible to say whether ECT treatment actually works faster than standard medications. Studies comparing various modalities of ECT have highlighted several factors that should be considered in any assessment of differential onset of antidepressant effect. First, patients are heterogeneous; that is, given any treatment or mode of treatment, some patients will respond, and some will not. Second, the choice of statistical method can significantly affect the interpretation of comparative onset data. Third, improved onset of action sometimes is achieved at the expense of tolerability. Thus, accelerating the onset of therapeutic response should not be an end in itself.
尽管长期以来临床一直认为电休克疗法（ECT）是治疗抑郁症最快的可用方法，但ECT尚未与药物疗法进行直接比较。因此，无法确定ECT治疗是否真的比标准药物起效更快。比较ECT各种方式的研究突出了几个因素，在评估抗抑郁作用的不同起效情况时应予以考虑。首先，患者具有异质性；也就是说，无论采用何种治疗或治疗方式，有些患者会有反应，有些则不会。其次，统计方法的选择会显著影响对比较起效数据的解释。第三，有时起效的改善是以耐受性为代价的。因此，加速治疗反应的起效本身不应成为目的。
