Zhand Naista, Courtney Darren B, Flament Martine F
From the *Department of Psychiatry, University of Ottawa, Ottawa; †Youth Concurrent Disorders Inpatient Unit, Centre for Addiction and Mental Health; ‡Department of Psychiatry, University of Toronto, Toronto; §Youth Unit at the University of Ottawa Institute of Mental Health Research; and ∥Department of Psychiatry and Psychology, University of Ottawa, Ottawa, Ontario, Canada.
J ECT. 2015 Dec;31(4):238-45. doi: 10.1097/YCT.0000000000000236.
This study presents a comprehensive case series of adolescents who received electroconvulsive therapy (ECT) for treatment-resistant depression.
Conducting a chart review, we identified 13 adolescents who had ECT for treatment of depression over a 5-year interval (2008-2013) at a Canadian tertiary care psychiatric hospital. Details about participants' clinical profile, index course of ECT, outcome, side effects, and comorbidities were extracted and analyzed.
Thirteen adolescents aged 15 to 18 years, received a mean of 14 (SD, 4.5) ECT sessions per patient. Based on the Beck Depression Inventory-II at baseline and after treatment with ECT, a reliable improvement was observed in 10 patients, with 3 achieving full recovery. Through mixed effects linear modeling, we found a decrease of 0.96 points (95% CI, -1.31 to -0.67, P < 0.001) on the Beck Depression Inventory-II total score for every ECT treatment received. The Montreal Cognitive Assessment was used for monitoring of cognitive function throughout the treatment. Adverse effects included transient subjective cognitive impairment (n = 11), headache (n = 10), muscular pain (n = 9), prolonged seizure (n = 3), and nausea and/or vomiting (n = 3).
A clinically significant improvement was observed for 10 (77%) adolescents receiving ECT for treatment-resistant depression. These observations suggest that ECT is a potential treatment option for refractory depression in selected adolescents. More data are needed to draw conclusions about efficacy and possible predictors of treatment response.
本研究呈现了一组接受电休克治疗（ECT）以治疗难治性抑郁症的青少年的综合病例系列。
通过病历回顾，我们确定了在加拿大一家三级护理精神病医院5年期间（2008 - 2013年）接受ECT治疗抑郁症的13名青少年。提取并分析了有关参与者临床特征、ECT索引疗程、结局、副作用和合并症的详细信息。
13名年龄在15至18岁的青少年，每位患者平均接受了14次（标准差4.5）ECT治疗。根据贝克抑郁量表第二版在基线和ECT治疗后，10名患者观察到可靠的改善，其中3名实现完全康复。通过混合效应线性模型，我们发现每次接受ECT治疗，贝克抑郁量表第二版总分下降0.96分（95%置信区间，-1.31至-0.67，P < 0.001）。在整个治疗过程中使用蒙特利尔认知评估来监测认知功能。不良反应包括短暂的主观认知障碍（n = 11）、头痛（n = 10）、肌肉疼痛（n = 9）、癫痫持续时间延长（n = 3）以及恶心和/或呕吐（n = 3）。
10名（77%）接受ECT治疗难治性抑郁症的青少年观察到具有临床意义的改善。这些观察结果表明，ECT是选定青少年难治性抑郁症的一种潜在治疗选择。需要更多数据来得出关于疗效和治疗反应可能预测因素的结论。
