Department of Psychiatry, Government Medical College, Srinagar, India.
Brain Stimul. 2010 Jan;3(1):28-35. doi: 10.1016/j.brs.2009.04.005. Epub 2009 May 27.
Treatment options are limited in patients with severe, chronic, posttraumatic stress disorder (PTSD). There is little information on the use of electroconvulsive therapy (ECT) for PTSD.
Between January 1, 2005, and December 31, 2005, all consenting adults (n=20) with severe, chronic, extensively antidepressant-refractory PTSD were prospectively treated with a fixed course of 6 bilateral ECT treatments administered on an outpatient basis at a twice-weekly frequency. The primary outcome measure was improvement on the Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS). Baseline refractoriness was defined as a failure to respond to an adequate course of at least 4 different antidepressant drugs along with 12 sessions of cognitive behavior therapy. Response to ECT was defined as at least 30% attenuation of CAPS ratings, and remission as an endpoint CAPS score of 20 or less. After ECT, patients were prescribed sertraline (100-150 mg/day) or mirtazapine (15-30 mg/day).
All but 3 patients completed the ECT course. An intent-to-treat analysis (n=20) showed statistically and clinically significant improvement in the sample as a whole: CAPS scores decreased by a mean of 34.4%, and depression scores by a mean of 51.1%. Most of the improvement in CAPS and depression ratings developed by the third ECT; that is, by day 10 of treatment, itself. The improvement in CAPS ratings was independent of the improvement in depression ratings; and improvement in CAPS did not differ significantly between patients with less severe vs more severe baseline depression. The response rate was 70%; no patient remitted. In the completer analysis (n=17), mean improvements were 40% and 57% for CAPS and depression ratings, respectively, and the response rate was 82%. Treatment gains were maintained at a 4-6 month follow-up.
ECT may improve the core symptoms of PTSD independently of improvement in depression, and may therefore be a useful treatment option for patients with severe, chronic, medication- and CBT-refractory PTSD.
在患有严重、慢性、创伤后应激障碍（PTSD）的患者中，治疗选择有限。关于电休克疗法（ECT）治疗 PTSD 的信息很少。
在 2005 年 1 月 1 日至 2005 年 12 月 31 日期间，所有同意的成年人（n=20）均患有严重、慢性、广泛抗抑郁药难治性 PTSD，前瞻性地接受固定疗程的 6 次双侧 ECT 治疗，每周两次，在门诊进行。主要结局指标是临床医生管理的创伤后应激障碍量表（CAPS）的改善。基线难治性定义为对至少 4 种不同抗抑郁药物的充分疗程以及 12 次认知行为治疗无反应。ECT 的反应定义为 CAPS 评分至少降低 30%，缓解定义为终点 CAPS 评分为 20 或更低。ECT 后，患者开服舍曲林（100-150mg/天）或米氮平（15-30mg/天）。
除 3 名患者外，所有患者均完成了 ECT 疗程。意向治疗分析（n=20）显示，整个样本在统计学和临床上均有显著改善：CAPS 评分平均下降 34.4%，抑郁评分平均下降 51.1%。CAPS 和抑郁评分的大部分改善发生在第三次 ECT 之后；也就是说，在治疗的第 10 天。CAPS 评分的改善与抑郁评分的改善无关；基线抑郁较轻和较重的患者之间 CAPS 评分的改善无显著差异。反应率为 70%；无患者缓解。在完成者分析（n=17）中，CAPS 和抑郁评分的平均改善分别为 40%和 57%，反应率为 82%。治疗效果在 4-6 个月的随访中得以维持。
ECT 可改善 PTSD 的核心症状，而与抑郁改善无关，因此可能是严重、慢性、药物和 CBT 难治性 PTSD 患者的有用治疗选择。
