Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J ECT. 2010 Sep;26(3):196-201. doi: 10.1097/YCT.0b013e3181eee13f.
Current guidelines regarding concomitant antidepressants during electroconvulsive therapy (ECT) are inconsistent. Although the American Psychiatric Association Task Force on ECT discouraged combination antidepressant treatment, owing to the minimal evidence for enhanced efficacy and concern about increased adverse effects, combination treatment is recommended and considered routine for many practitioners in the United States and other parts of the world. Considering the increasing levels of treatment resistance among patients referred for ECT and the high relapse rate after acute ECT, the role of concomitant antidepressant pharmacotherapy during ECT should be reevaluated. More research, however, is needed to explore the impact of administering specific antidepressants during acute and maintenance ECT (M-ECT), on antidepressant efficacy and cognitive adverse effects. This will require appropriately controlled studies of ECT medication combinations that include attention to a range of cognitive function measures and clinical response. In addition, the role of combination ECT and psychotropic medication in the treatment of mania and schizophrenia continues to receive attention, particularly in those patients who have shown inadequate responses to psychotropic medication alone. Although there is insufficient evidence to support the routine addition of antipsychotic medications to ECT during the treatment of acute mania, the literature suggests that it is unnecessary to discontinue antipsychotic medication when ECT is added to the treatment of a manic patient that has been unresponsive to pharmacological treatment. Despite the lack of well-controlled studies, the existing literature suggests that combination ECT and antipsychotic treatment is a useful option for patients with schizophrenia who are unresponsive to pharmacological interventions alone, and its adverse effect profile does not seem different from that seen with ECT alone.
目前关于电抽搐治疗(ECT)期间合并使用抗抑郁药物的指南并不一致。尽管美国精神病学协会 ECT 工作组不鼓励联合使用抗抑郁药物,因为增强疗效的证据有限,而且担心不良反应增加,但在美国和世界其他地区的许多医生仍推荐并认为联合治疗是常规治疗。考虑到接受 ECT 治疗的患者的治疗抵抗水平不断提高,以及急性 ECT 后复发率高,ECT 期间合并使用抗抑郁药物的作用应重新评估。然而,需要更多的研究来探讨在急性和维持性 ECT(M-ECT)期间给予特定抗抑郁药物对抗抑郁疗效和认知不良反应的影响。这将需要对 ECT 药物联合进行适当对照研究,包括关注一系列认知功能测量和临床反应。此外,联合 ECT 和精神药物在治疗躁狂症和精神分裂症中的作用继续受到关注,特别是在那些对单独使用精神药物反应不足的患者中。尽管没有足够的证据支持在治疗急性躁狂症时常规添加抗精神病药物到 ECT 中,但文献表明,当 ECT 被添加到对药物治疗无反应的躁狂症患者的治疗中时,没有必要停止抗精神病药物。尽管缺乏良好对照的研究,但现有文献表明,对于对单独药物干预无反应的精神分裂症患者,联合 ECT 和抗精神病药物治疗是一种有用的选择,其不良反应谱似乎与单独 ECT 无差异。