Mayo Clinic, Department of Psychiatry and Psychology-W11, 200 First Street, SW, Rochester, MN 55905, USA.
J Clin Psychiatry. 2010 Feb;71(2):185-93. doi: 10.4088/JCP.08m04797gre.
To compare the memory effects of continuation electroconvulsive therapy (C-ECT) versus continuation pharmacologic intervention (C-PHARM) at 12 and 24 weeks after completion of acute electroconvulsive therapy (ECT).
Eighty-five patients with Structured Clinical Interview for DSM-IV-diagnosed unipolar major depressive disorder, enrolled in a multisite, randomized, parallel-design trial conducted at 5 academic medical centers from 1997 to 2004, who had remitted with an acute course of bilateral ECT and remained unrelapsed through 24 weeks of continuation therapy, were included in this analysis. They were randomly assigned to C-ECT (10 treatments) or nortriptyline plus lithium (monitored by serum blood levels) for 24 weeks. Objective neuropsychological measures of retrograde and anterograde memory and subjective assessment of memory were obtained at baseline, 12 weeks, and 24 weeks. The Rey Auditory-Verbal Learning Test and the Autobiographical Memory Interview were the primary outcome measures.
The C-PHARM group showed a greater group difference (P < .01) for baseline to 12-week change for the Autobiographical Memory Interview. No other memory measures showed group differences for change scores from baseline to 12 weeks. Groups showed no baseline to 24-week change-score differences on any of the memory measures. For both groups, 12-week objective anterograde memory scores (eg, Auditory-Verbal Learning Test percent retention P = .0001; Rey-Osterrieth Complex Figure or Taylor Figure percent retention P < .002) and 24-week subjective memory scores were significantly improved (Squire Subjective Memory Questionnaire P < .02) over baseline. This result reflects the apparent resolution of a presumed decrement in anterograde memory associated with acute ECT preceding this study.
The finding of no memory outcome differences between unrelapsed recipients of C-ECT and C-PHARM is consistent with clinical experience. Memory effects have only a small role in the choice between C-ECT and C-PHARM.
比较急性电抽搐治疗（ECT）结束后 12 周和 24 周时继续电抽搐治疗（C-ECT）与继续药物干预（C-PHARM）的记忆效果。
本研究纳入了 85 名患有经 DSM-IV 诊断的单相重性抑郁障碍的患者，他们参加了 1997 年至 2004 年在 5 个学术医疗中心进行的一项多中心、随机、平行设计试验，这些患者在急性双侧 ECT 治疗后缓解，并且在 24 周的维持治疗期间没有复发。他们被随机分配到 C-ECT（10 次治疗）或去甲替林加锂（通过血清血药水平监测）治疗 24 周。在基线、12 周和 24 周时，进行了逆行和顺行记忆的客观神经心理学测量以及记忆的主观评估。 Rey 听觉语言学习测试和自传体记忆访谈是主要的结局指标。
C-PHARM 组在自传体记忆访谈中，从基线到 12 周的变化方面显示出更大的组间差异（P<.01）。其他记忆测量在从基线到 12 周的变化评分方面没有显示出组间差异。两组在任何记忆测量的基线到 24 周的变化评分方面均无差异。对于两组患者，12 周的客观顺行记忆评分（例如，听觉语言学习测试的保留率百分比 P=0.0001； Rey-Osterrieth 复杂图形或 Taylor 图形的保留率百分比 P<.002）和 24 周的主观记忆评分（Squire 主观记忆问卷 P<.02）均显著高于基线。这一结果反映了本研究之前急性 ECT 引起的顺行记忆减退的明显缓解。
未发现继续电抽搐治疗组和继续药物治疗组的记忆结局存在差异，这与临床经验一致。记忆效应在继续电抽搐治疗和继续药物治疗之间的选择中仅起很小的作用。
