Baghai Thomas C, Marcuse Alain, Brosch Melanie, Schüle Cornelius, Eser Daniela, Nothdurfter Caroline, Steng Yvonne, Noack Ines, Pietschmann Katrin, Möller Hans-Jürgen, Rupprecht Rainer
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
World J Biol Psychiatry. 2006;7(2):82-90. doi: 10.1080/15622970500213871.
A major problem in the treatment of severe depression is the onset latency until clinical improvement. So far, electroconvulsive therapy (ECT) is the most effective somatic treatment of depression. This holds especially true for treatment-refractory disturbances. However, not all patients respond to conventional unilateral ECT. In certain cases, subsequent clinical response can be achieved using bilateral or high-dose unilateral ECT. Also, a concomitant pharmacotherapy can be utilized to augment therapeutic effectiveness. Surprisingly, data in this field are widely lacking and only few studies showed advantages of an ECT/tricyclic antidepressant combination.
We retrospectively evaluated 5482 treatments in 455 patients to investigate possible therapeutic advantages in combination therapies versus ECT monotherapy. Main outcome criteria were clinical effectiveness and tolerability. Moreover, treatment modalities and ictal neurophysiological parameters that might influence treatment outcome were analysed.
A total of 18.2% of our treatments were ECT monotherapy, 8.87% were done with one antidepressant. Seizure duration was unaffected by the most antidepressants. SSRI caused a lengthened seizure activity. Postictal suppression was lower in mirtazapine and higher in SSRI and SNRI treated patients. A significant enhancement of therapeutic effectiveness could be seen in the patient group receiving tricyclics, SSRI or mirtazapine. Serious adverse events were not recorded.
Our study supports the hypothesis that mirtazapine can be used to enhance the therapeutic effectiveness of ECT. Controlled studies are necessary to further investigate the possible advantages of ECT and pharmacotherapy combinations, especially the use of modern dually acting antidepressants which have proven their good effectiveness in treatment-resistant depression.
重度抑郁症治疗中的一个主要问题是直至临床改善的起效潜伏期。到目前为止，电休克疗法（ECT）是治疗抑郁症最有效的躯体治疗方法。这在治疗难治性障碍方面尤其如此。然而，并非所有患者对传统单侧ECT都有反应。在某些情况下，使用双侧或高剂量单侧ECT可实现后续临床反应。此外，可利用联合药物治疗来增强治疗效果。令人惊讶的是，该领域的数据广泛缺乏，只有少数研究显示ECT/三环类抗抑郁药联合治疗的优势。
我们回顾性评估了455例患者的5482次治疗，以研究联合治疗与ECT单一疗法相比可能存在的治疗优势。主要结局标准为临床疗效和耐受性。此外，分析了可能影响治疗结果的治疗方式和发作期神经生理参数。
我们的治疗中共有18.2%为ECT单一疗法，8.87%是与一种抗抑郁药联合使用。发作持续时间不受大多数抗抑郁药影响。选择性5-羟色胺再摄取抑制剂（SSRI）会导致发作活动延长。米氮平治疗的患者发作后抑制较低，而SSRI和5-羟色胺及去甲肾上腺素再摄取抑制剂（SNRI）治疗的患者发作后抑制较高。在接受三环类药物、SSRI或米氮平治疗的患者组中可观察到治疗效果显著增强。未记录到严重不良事件。
我们的研究支持米氮平可用于增强ECT治疗效果这一假说。有必要进行对照研究，以进一步探究ECT与药物治疗联合使用的可能优势，尤其是使用已在难治性抑郁症中证明其良好疗效的新型双重作用抗抑郁药。
