Prudic Joan, Olfson Mark, Marcus Steven C, Fuller Rice B, Sackeim Harold A
Department of Biological Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 126, New York, NY 10032, USA
Biol Psychiatry. 2004 Feb 1;55(3):301-12. doi: 10.1016/j.biopsych.2003.09.015.
Clinical trials indicate that electroconvulsive therapy (ECT) is the most effective treatment for major depression, but its effectiveness in community settings has not been examined.
In a prospective, naturalistic study involving 347 patients at seven hospitals, clinical outcomes immediately after ECT and over a 24-week follow-up period were examined in relation to patient characteristics and treatment variables.
The sites differed markedly in patient features and ECT administration but did not differ in clinical outcomes. In contrast to the 70%-90% remission rates expected with ECT, remission rates, depending on criteria, were 30.3%-46.7%. Longer episode duration, comorbid personality disorder, and schizoaffective disorder were associated with poorer outcome. Among remitters, the relapse rate during follow-up was 64.3%. Relapse was more frequent in patients with psychotic depression or comorbid Axis I or Axis II disorders. Only 23.4% of ECT nonremitters had sustained remission during follow-up.
The remission rate with ECT in community settings is substantially less than that in clinical trials. Providers frequently end the ECT course with the view that patients have benefited fully, yet formal assessment shows significant residual symptoms. Patients who do not remit with ECT have a poor prognosis; this underscores the need to achieve maximal improvement with this modality.
临床试验表明，电休克疗法（ECT）是治疗重度抑郁症最有效的方法，但尚未对其在社区环境中的有效性进行研究。
在一项涉及7家医院347名患者的前瞻性自然主义研究中，研究了ECT治疗后即刻以及24周随访期内的临床结局与患者特征和治疗变量之间的关系。
各研究地点的患者特征和ECT治疗方式存在显著差异，但临床结局并无差异。与ECT预期的70%-90%的缓解率相比，根据不同标准，缓解率为30.3%-46.7%。发作持续时间较长、合并人格障碍和分裂情感性障碍与较差的结局相关。在缓解者中，随访期间的复发率为64.3%。精神病性抑郁症或合并轴I或轴II障碍的患者复发更为频繁。ECT治疗未缓解的患者中，只有23.4%在随访期间持续缓解。
社区环境中ECT的缓解率远低于临床试验中的缓解率。医疗服务提供者常常认为患者已充分受益而结束ECT疗程，但正式评估显示仍有明显的残留症状。ECT治疗未缓解的患者预后较差；这凸显了通过这种治疗方式实现最大程度改善的必要性。
