Heijnen Willemijn T C, van den Broek Walter W, Birkenhäger Tom K
Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.
J Clin Psychiatry. 2008 Dec;69(12):1887-91. doi: 10.4088/jcp.v69n1206. Epub 2008 Oct 7.
To examine the predictive value of resistance to a tricyclic antidepressant (TCA) and lithium with respect to the efficacy of subsequent electroconvulsive therapy (ECT).
This open prospective study was conducted in the inpatient depression unit of a university hospital in The Netherlands. Patients were enrolled in the study from October 1996 to June 2002 and had to meet DSM-IV criteria for major depressive disorder. Eighty-six patients were treated twice weekly with ECT until recovery or no progress during at least 10 bilateral treatments. Patients were maintained drug free during the ECT treatment. Clinical evaluation of depressive symptoms was performed each week; scores on the 17-item version of the Hamilton Rating Scale for Depression (HAM-D) were obtained 1 to 3 days prior to ECT and 1 to 3 days after treatment termination. The primary outcome criterion was defined as the mean difference in HAM-D score before and after ECT for patients who had received adequate treatment with a TCA and lithium compared with patients who had not received adequate treatment with a TCA and lithium. Adequate treatment was defined as 4 weeks taking a predefined plasma level of a TCA; nonresponders had lithium added to the medication, and the minimal duration of the lithium addition was 3 weeks with a plasma level of at least 0.6 mmol/L. Independent samples t test was used to analyze this primary outcome criterion.
According to the primary outcome criterion, patients who had received adequate treatment with a TCA and lithium (N = 56) had a mean difference in HAM-D score pre-ECT and post-ECT of 16.4 compared to a HAM-D score difference of 19.5 in the patient group who had received inadequate treatment with a TCA and lithium (N = 30). This inequality in differences in mean HAM-D scores is not significant (p = .2).
In the present study sample, treatment failure with adequate pharmacotherapy with a TCA and lithium addition appears to be unrelated to outcome following subsequent ECT.
探讨对三环类抗抑郁药（TCA）和锂盐耐药性对于后续电休克治疗（ECT）疗效的预测价值。
这项开放性前瞻性研究在荷兰一家大学医院的住院抑郁症病房进行。1996年10月至2002年6月期间招募患者，患者必须符合DSM-IV中重度抑郁症的标准。86例患者每周接受两次ECT治疗，直至康复或在至少10次双侧治疗后无进展。ECT治疗期间患者保持无药状态。每周进行抑郁症状的临床评估；在ECT治疗前1至3天和治疗结束后1至3天获得17项版汉密尔顿抑郁量表（HAM-D）评分。主要结局标准定义为接受TCA和锂盐充分治疗的患者与未接受TCA和锂盐充分治疗的患者在ECT前后HAM-D评分的平均差异。充分治疗定义为服用预定血浆水平的TCA 4周；无反应者在药物中添加锂盐，锂盐添加的最短持续时间为3周，血浆水平至少为0.6 mmol/L。使用独立样本t检验分析这一主要结局标准。
根据主要结局标准，接受TCA和锂盐充分治疗的患者（N = 56）在ECT前后的HAM-D评分平均差异为16.4，而接受TCA和锂盐不充分治疗的患者组（N = 30）的HAM-D评分差异为19.5。平均HAM-D评分差异的这种不平等不显著（p = 0.2）。
在本研究样本中，TCA和添加锂盐的充分药物治疗失败似乎与后续ECT的结局无关。
