Spaans Harm-Pieter, Kok Rob M, Bouckaert Filip, Van Den Berg Julia F, Tunney Orlaith C, Sienaert Pascal, Verwijk Esmée, Kho King H, Stek Max L
Parnassia Psychiatric Institute, The Hague, The Netherlands.
AcCENT - Academic Center for ECT and Neuromodulation, University Psychiatric Center, KU Leuven (Catholic University of Leuven), Campus Kortenberg, Kortenberg, Belgium.
Int J Geriatr Psychiatry. 2018 Feb;33(2):371-378. doi: 10.1002/gps.4754. Epub 2017 Jun 28.
Research suggests that in depression, vascular burden predicts a lower efficacy for medication (MED) and a more favourable outcome for electroconvulsive therapy (ECT). Therefore, we investigated the influence of the following vascular risk factors (VRF): hypercholesterolemia, hypertension, smoking, diabetes mellitus, cardiovascular disease, and cerebral vascular accident/transient ischemic attack, on remission from major depression after ECT versus MED.
The study sample consisted of 81 inpatients with a DSM-IV unipolar major depression diagnosis (mean age 72.2 years, SD = 7.6, mean Montgomery-Åsberg Depression Rating Scale score 32.9, SD = 6.2) participating in a randomized controlled trial comparing nortriptyline versus venlafaxine and 43 inpatients (mean age 73.7 years, SD = 7.5, mean Montgomery-Åsberg Depression Rating Scale score 30.6, SD = 7.1) from an randomized controlled trial comparing brief pulse versus ultrabrief pulse ECT. The presence of VRF was established from the medical records. The remission rate of patients with VRF was compared with those of patients without VRF.
The remission rate was 58% (19/33) in the ECT group with ≥1 VRF and 32% (23/73) in the MED group with ≥1 VRF (χ = 6.456, p = 0.011). Comparing patients with no VRF versus ≥1 VRF, the remission rate decreased from 80 to 58% (χ = 1.652, p = 0.276) in ECT patients and from 38 to 32% (χ = 0.119, p = 0.707) in MED patients. Applying different cut-offs for the number of VRFs yielded the same trends. Logistic regression revealed no interaction between VRF and treatment condition.
The superior efficacy of ECT over pharmacotherapy in major depression in older age was independent of the presence of VRF. Copyright © 2017 John Wiley & Sons, Ltd.
研究表明，在抑郁症中，血管负担预示着药物治疗（MED）疗效较低，而电休克治疗（ECT）预后更佳。因此，我们调查了以下血管危险因素（VRF）：高胆固醇血症、高血压、吸烟、糖尿病、心血管疾病以及脑血管意外/短暂性脑缺血发作，对ECT与MED治疗后重度抑郁症缓解情况的影响。
研究样本包括81例符合DSM-IV单相重度抑郁症诊断标准的住院患者（平均年龄72.2岁，标准差=7.6，蒙哥马利-阿斯伯格抑郁评定量表平均得分32.9，标准差=6.2），他们参与了一项比较去甲替林与文拉法辛的随机对照试验；以及43例住院患者（平均年龄73.7岁，标准差=7.5，蒙哥马利-阿斯伯格抑郁评定量表平均得分30.6，标准差=7.1），他们来自一项比较短脉冲与超短脉冲ECT的随机对照试验。通过病历确定VRF的存在情况。将有VRF的患者缓解率与无VRF的患者缓解率进行比较。
ECT组中≥1种VRF的患者缓解率为58%（19/33），MED组中≥1种VRF的患者缓解率为32%（23/73）（χ=6.456，p=0.011）。比较无VRF与≥1种VRF的患者，ECT患者的缓解率从（χ=1.652，p=0.276）80%降至58%，MED患者的缓解率从38%降至32%（χ=0.119，p=0.707）。对VRF数量采用不同的临界值得出相同趋势。逻辑回归显示VRF与治疗条件之间无相互作用。
ECT在老年重度抑郁症中的疗效优于药物治疗，且与VRF的存在无关。版权所有©2017约翰威立父子有限公司。
