Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
J Clin Psychiatry. 2010 Jun;71(6):775-7. doi: 10.4088/JCP.08m04971gre. Epub 2009 Dec 29.
Electroconvulsive therapy (ECT) is performed under anesthesia and muscle relaxation. Only well-generalized seizures seem to have the high "adequacy" or "quality" that have been claimed to reflect positive predictive power for the outcome of an ECT course. The induction of well-generalized seizures can be potentially influenced by several variables. One major variable is concurrent medication including anesthetic drugs, since most anesthetic drugs are potent anticonvulsives. We hypothesized a negative influence of anesthetics and benzodiazepines but a positive effect of antidepressants and antipsychotics concurrently applied during ECT on seizure adequacy.
We included inpatients (n = 41) with a DSM-IV-diagnosed major depressive episode treated with ECT (411 ECT sessions) during a period of 20 months (May 2005 to December 2006) in an open label and noncontrolled study. A repeated measurement regression analysis was performed with 8 seizure adequacy parameters as dependent variables. We indirectly quantified narcotic agent influence with bispectral index monitoring.
In contrast to the impact of psychiatric comedication, this measure of "depth of narcosis" prior stimulation turned out to influence most seizure adequacy parameters in a highly significant manner.
Thus, we concluded that the anticonvulsive properties of narcotic agents have much higher influence than concomitant psychotropic medication. Our data support the view that a significant influence of concurrent psychotropic drugs on seizure adequacy markers is missing, especially when directly compared with other confounders like stimulation energy, age, and depth of narcosis. The latter suggests to further prove the idea that lighter anesthesia is indeed an important tool to get patients faster into remission.
电痉挛疗法（ECT）是在麻醉和肌肉松弛下进行的。只有广泛发作的癫痫似乎具有所谓的“充分性”或“质量”，这被认为反映了 ECT 疗程结果的阳性预测能力。广泛发作的癫痫的诱导可能受到几个变量的影响。一个主要变量是同时使用的药物，包括麻醉药物，因为大多数麻醉药物都是有效的抗惊厥药物。我们假设麻醉剂和苯二氮䓬类药物会产生负面影响，但在 ECT 期间同时使用抗抑郁药和抗精神病药会对癫痫发作的充分性产生积极影响。
我们在一项开放标签、非对照研究中纳入了 20 个月（2005 年 5 月至 2006 年 12 月）期间因 DSM-IV 诊断的重度抑郁症而接受 ECT（411 次 ECT 疗程）的住院患者（n=41）。使用重复测量回归分析将 8 个癫痫发作充分性参数作为因变量。我们使用双频谱指数监测间接量化麻醉剂的影响。
与精神科合并用药的影响相反，刺激前这种“麻醉深度”的测量结果对大多数癫痫发作充分性参数有显著影响。
因此，我们得出结论，麻醉剂的抗惊厥特性比同时使用的精神药物有更大的影响。我们的数据支持这样一种观点，即同时使用的精神药物对癫痫发作充分性标志物的影响并不显著，特别是当与其他混杂因素（如刺激能量、年龄和麻醉深度）直接比较时。后一种情况表明，有必要进一步证明较轻的麻醉确实是使患者更快缓解的重要工具的观点。
