Dennis Nora M, Dennis Paul A, Shafer Alan, Weiner Richard D, Husain Mustafa M
From the *Durham Veterans Affairs Medical Center, Durham; †Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; ‡Mental Health and Substance Abuse Division, Texas Department of State Health Services, Austin; §University of Texas Southwestern Medical Center, Dallas, TX.
J ECT. 2017 Mar;33(1):22-25. doi: 10.1097/YCT.0000000000000340.
Electroconvulsive therapy (ECT) remains an effective treatment for major depressive disorder. Since 1995, Texas has maintained an ECT database including patient diagnoses and outcomes, and reporting any deaths within 14 days of receiving an ECT treatment, encompassing a total of 166,711 ECT treatments administered in Texas over the previously unreported period of 1998 to 2013.
Descriptive analysis summarized information on deaths reported during the 16-year period-cause of death, type of treatment (index or maintenance) and patient demographics. Multiple logistic regression of death incidence by treatment session was performed to determine whether patient age, sex, race, diagnosis, or year of treatment was associated with death after ECT.
Of those deaths occurring within 1 day of an ECT treatment, the death rate was 2.4 per 100,000 treatments. Looking at all deaths within 14 days of an ECT treatment, the death rate increased to 18 per 100,000 treatments but included all deaths regardless of likelihood of causal association with ECT, for example, accidents and suicides, the latter a leading cause of death among individuals with severe major depression or other disorders for which ECT is indicated. Death rate increased significantly with increasing patient age (P = 0.001) and male sex (P = 0.009), and there was a nonsignificant trend toward increased death amongst patients with bipolar disorder or schizophrenia (P = 0.058) versus depression.
Our data indicate that ECT is in general a safe procedure with respect to the likelihood of immediate death. Suicide remains a significant risk in ECT patients, despite evidence that ECT reduces suicidal ideation.
电休克疗法（ECT）仍然是治疗重度抑郁症的一种有效方法。自1995年以来，得克萨斯州维护了一个ECT数据库，其中包括患者诊断信息和治疗结果，并报告在接受ECT治疗后14天内发生的任何死亡情况，涵盖了1998年至2013年之前未报告的时期内在得克萨斯州进行的总共166,711次ECT治疗。
描述性分析总结了16年期间报告的死亡信息——死亡原因、治疗类型（首次治疗或维持治疗）和患者人口统计学特征。对每次治疗疗程的死亡发生率进行多因素逻辑回归分析，以确定患者年龄、性别、种族、诊断或治疗年份是否与ECT治疗后的死亡相关。
在ECT治疗后1天内发生的死亡中，死亡率为每100,000次治疗2.4例。查看ECT治疗后14天内的所有死亡情况，死亡率升至每100,000次治疗18例，但包括所有死亡，无论与ECT有因果关联的可能性如何，例如事故和自杀，后者是重度抑郁症或其他适用ECT治疗的疾病患者的主要死亡原因。死亡率随着患者年龄的增加（P = 0.001）和男性性别（P = 0.009）而显著增加，并且双相情感障碍或精神分裂症患者（P = 0.058）与抑郁症患者相比，死亡增加的趋势不显著。
我们的数据表明，就即刻死亡的可能性而言，ECT总体上是一种安全的治疗方法。尽管有证据表明ECT可减少自杀意念，但自杀仍然是ECT患者的重大风险。
