Burke Michael J, Husain Mustafa M
Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS.
J ECT. 2006 Sep;22(3):218-22. doi: 10.1097/01.yct.0000230364.04240.52.
This study explored the use of electroconvulsive therapy (ECT) in the pivotal study of vagus nerve stimulation (VNS) for treatment-resistant depression.
The clinical characteristics and outcomes of study participants who received ECT during the first 12 months of VNS were compared with those who did not receive ECT. Physicians were instructed to turn off VNS during administration of ECT.
Of 205 (evaluable sample) patients who received VNS, 14 also received ECT. Participants who received ECT had a statistically significant greater number of hospital admissions (P = 0.037, Wilcoxon) and number of suicide attempts during their lifetimes (P= 0.022, Fisher exact test). Of 55 responders (> or =50% reduction in Hamilton Rating Scale for Depression-24 questions [HRSD-24] scores) after 12 months of VNS, 3 had received ECT. Of 32 remitters (HRSD-24 score, < or =9), 2 had received ECT. Administration of ECT did not affect the implanted VNS device, and the presence of the implanted VNS device did not affect the administration of ECT.
Electroconvulsive therapy and VNS are not mutually exclusive. They can be used safely and effectively either sequentially or concurrently. Each can be prescribed as the depressive condition warrants-ECT for emergently worsening depressive symptoms and maintenance therapy and VNS for chronic, long-term therapy.
本研究探讨了在迷走神经刺激（VNS）治疗难治性抑郁症的关键研究中电休克疗法（ECT）的应用。
将在VNS治疗的前12个月内接受ECT的研究参与者的临床特征和结果与未接受ECT的参与者进行比较。指示医生在ECT治疗期间关闭VNS。
在205名接受VNS治疗的患者（可评估样本）中，有14名也接受了ECT治疗。接受ECT治疗的参与者一生中的住院次数（P = 0.037，Wilcoxon检验）和自杀未遂次数在统计学上显著更多（P = 0.022，Fisher精确检验）。在VNS治疗12个月后，55名有反应者（汉密尔顿抑郁量表24项评分[HRSD-24]降低≥50%）中，有3名接受了ECT治疗。在32名缓解者（HRSD-24评分≤9）中，有2名接受了ECT治疗。ECT治疗未影响植入的VNS设备，植入的VNS设备也未影响ECT治疗的实施。
电休克疗法和VNS并非相互排斥。它们可以安全有效地序贯或同时使用。每种疗法都可根据抑郁状况进行处方——ECT用于紧急恶化的抑郁症状和维持治疗，VNS用于慢性长期治疗。
