Gupta Susham, Tobiansky Rob, Bassett Paul, Warner James
Central and North West London Foundation Trust, London, UK.
J ECT. 2008 Sep;24(3):191-4. doi: 10.1097/YCT.0b013e3181608bf2.
The use of maintenance electroconvulsive therapy (mECT) in contemporary psychiatric practice is controversial. In the United Kingdom, the National Institute for Health and Clinical Excellence has recommended that mECT should not be used, although evidence underpinning this decision is lacking. Undertaking a randomized evaluation of this treatment would now be very difficult in the United Kingdom. The main aim of this study is to evaluate the efficacy of mECT in reducing recurrence in depression.
A retrospective analysis of 19 patients who had responded positively to an index and continuation course of ECT and then proceeded to receive mECT. We compared the number of hospital admissions and duration of hospital stay over 3 time periods: 2 years before ECT, during mECT, and up to 4 years after cessation of mECT. To account for secular trends in service use, we also compared the admission rates of this group with a matched sample who received successful index ECT followed by other maintenance therapies (comparison group).
Participants received an average of 37 applications of mECT over a median period of 26 months. Inpatient hospital stay and rate of admissions to an acute psychiatric unit fell significantly during the period of mECT compared with the rates before the initiation of mECT. This reduction in bed use was maintained after termination of mECT. No reduction of service use was observed in the comparison group.
The findings suggest that mECT may have a role in reducing the rate and duration of hospital stay of patients with major depressive disorder.
在当代精神病学实践中，维持性电休克治疗（mECT）的应用存在争议。在英国，国家卫生与临床优化研究所建议不应使用mECT，尽管支持这一决定的证据不足。目前在英国对这种治疗进行随机评估非常困难。本研究的主要目的是评估mECT在降低抑郁症复发率方面的疗效。
对19例在接受首次及后续电休克治疗时反应良好并随后接受mECT的患者进行回顾性分析。我们比较了三个时间段内的住院次数和住院时长：电休克治疗前2年、mECT治疗期间以及mECT停止后长达4年。为了考虑服务使用的长期趋势，我们还将该组的住院率与接受成功首次电休克治疗后采用其他维持治疗的匹配样本（对照组）进行了比较。
参与者在中位时间26个月内平均接受了37次mECT治疗。与开始mECT治疗前相比，mECT治疗期间住院患者的住院时长和入住急性精神科病房的比率显著下降。mECT治疗结束后，床位使用的这种减少情况得以维持。对照组未观察到服务使用的减少。
研究结果表明，mECT可能在降低重度抑郁症患者的住院率和住院时长方面发挥作用。
