Diakonhjemmet Hospital, Department of Geriatric Psychiatry, Pastor Fangens vei 18, 0854 Oslo, Norway.
Norwegian Centre for Aging and Health, Vestfold Health Trust, Tønsberg, Norway.
J Affect Disord. 2015 Apr 1;175:8-17. doi: 10.1016/j.jad.2014.12.054. Epub 2014 Dec 31.
No prior study has compared the efficacy of bifrontal (BF) vs right unilateral (RUL) electroconvulsive therapy (ECT) by including the subgroup that is most likely to receive it: only elderly patients with major depression (MD).
This single-site, randomized, assessor-blinded, controlled trial was conducted from 2009 to 2013. Seventy-three elderly patients with MD, unipolar and bipolar, were treated with a course of formula-based BF ECT or RUL ECT. The 17-item Hamilton Rating Scale for Depression (HRSD17) was used to measure efficacy. Safety was assessed with the Mini Mental State Examination (MMSE).
Both electrode placements resulted in highly significant downward trends in symptom severity (all p<0.001), with a non-significant difference between methods (p=0.703). At the end of the ECT course, response rates for the BF and RUL group were 63.9% and 67.6%, respectively. Short-term remission, defined as an HRSD17 score≤7, was achieved in 14 (38.9%) patients in the BF group and 19 (51.4%) patients in the RUL group. Global cognitive function, as measured by the MMSE, did not deteriorate in the two treatment groups.
The small number of subjects may have led to reduced power to detect real differences. The MMSE is not sufficient to ascertain the negative effect of ECT on cognition.
This study indicates that formula-based BF and RUL ECT are equally efficacious, and that remission rates of formula-based dosing are lower than those previously reported for titrated dosing, in a clinical sample of elderly patients with MD.
ClinicalTrials.gov NCT01559324.
此前尚无研究通过纳入最有可能接受治疗的亚组（即仅有老年重性抑郁症患者）比较双额（BF）与右单侧（RUL）电抽搐治疗（ECT）的疗效。
这项单中心、随机、评估者设盲、对照试验于 2009 年至 2013 年进行。73 例单相和双相的老年重性抑郁症患者接受基于公式的 BF ECT 或 RUL ECT 治疗。使用 17 项汉密尔顿抑郁量表（HRSD17）评估疗效。采用简易精神状态检查（MMSE）评估安全性。
两种电极放置均导致症状严重程度呈显著下降趋势（均 p<0.001），但两种方法之间无显著差异（p=0.703）。ECT 疗程结束时，BF 组和 RUL 组的反应率分别为 63.9%和 67.6%。BF 组中 14 例（38.9%）和 RUL 组中 19 例（51.4%）达到短期缓解，定义为 HRSD17 评分≤7。作为 MMSE 测量的全球认知功能在两组治疗中均未恶化。
受试者数量较少可能导致无法检测到真实差异。MMSE 不足以确定 ECT 对认知的负面影响。
本研究表明，基于公式的 BF 和 RUL ECT 同样有效，且基于公式的剂量方案缓解率低于先前报告的滴定剂量方案，这在老年重性抑郁症患者的临床样本中得到了证实。
ClinicalTrials.gov NCT01559324。
