Mayur Prashanth, Howari Rasha, Byth Karen, Vannitamby Rameswaran
Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Victoria.
Biostatistics, University of Sydney.
J ECT. 2018 Dec;34(4):291-295. doi: 10.1097/YCT.0000000000000479.
The feasibility and effectiveness of concomitant use of transcranial direct current stimulation (tDCS) with electroconvulsive therapy (ECT) has not been investigated. The study principally aimed at determining whether tDCS when combined with ECT improved the speed of antidepressant response. Secondarily, the ease of generation of seizures during electroconvulsive therapy and cognitive outcomes were investigated.
Consecutive patients referred for ECT to treat major depression were randomized to tDCS with dorsolateral prefrontal electrode placements (n = 8) or sham (n = 8) used daily and just before thrice weekly, 6 times threshold, right unilateral ultrabrief (0.3 ms) pulse width ECT. Change of depression severity was determined using the Montgomery Asberg Depression Rating Scale along with cognitive assessments using Montreal Cognitive Assessment and visual memory testing at weeks 1 and 2, which were compared with baseline.
Change of depression severity from baseline was similar in tDCS and ECT compared with sham tDCS and ECT at week1 (mean [standard deviation {SD}] = 16.00 [6.78]; 13.75 [7.83]; P = 0.89) and at week 2 (mean [SD] = 23.00 [4.96]; 19.75 [9.85], P = 0.08). No between-group differences were obtained in the cognitive tests at weeks 1 and 2. Combining tDCS with ECT resulted in higher restimulation: 62.5% requiring 3 stimulations to achieve threshold in contrast to 12.5% with sham tDCS and ECT (P = 0.04). The mean suprathreshold dose was higher in the tDCS and ECT group compared with sham tDCS and ECT: mean [SD] = 144.0 [43.54] and mean [SD] = 122.4 [20.36], P = 0.04, respectively.
Concomitant use of tDCS with ultrabrief right unilateral ECT is feasible and safe albeit with higher rates of restimulation when tDCS was combined with ECT. However, there were no statistically significant differences in the speed of antidepressant response or cognitive outcomes at weeks 1 and 2 after the commencement of treatments.
经颅直流电刺激（tDCS）与电休克治疗（ECT）联合使用的可行性和有效性尚未得到研究。本研究主要旨在确定tDCS与ECT联合使用是否能提高抗抑郁反应的速度。其次，研究了电休克治疗期间癫痫发作的易发性和认知结果。
连续转诊接受ECT治疗重度抑郁症的患者被随机分为两组，一组采用背外侧前额叶电极放置的tDCS（n = 8），另一组采用假刺激（n = 8），每天使用，且在每周三次、每次6次阈值的右侧单侧超短脉冲（0.3毫秒）宽度的ECT治疗前使用。使用蒙哥马利-阿斯伯格抑郁评定量表确定抑郁严重程度的变化，并在第1周和第2周使用蒙特利尔认知评估和视觉记忆测试进行认知评估，将其与基线进行比较。
在第1周时，tDCS联合ECT组与假刺激tDCS联合ECT组相比，抑郁严重程度从基线的变化相似（均值[标准差{SD}] = 16.00 [6.78]；13.75 [7.83]；P = 0.89），在第2周时也相似（均值[SD] = 23.00 [4.96]；19.75 [9.85]，P = 0.08）。在第1周和第2周的认知测试中未获得组间差异。tDCS与ECT联合使用导致更高的再次刺激率：62.5%的患者需要3次刺激才能达到阈值，而假刺激tDCS联合ECT组为12.5%（P = 0.04）。tDCS联合ECT组的平均阈上剂量高于假刺激tDCS联合ECT组：均值[SD] = 144.0 [43.54]和均值[SD] = 122.4 [20.36]，P分别为0.04。
tDCS与超短右侧单侧ECT联合使用是可行且安全的，尽管tDCS与ECT联合使用时再次刺激率较高。然而，在治疗开始后的第1周和第2周，抗抑郁反应速度或认知结果方面没有统计学上的显著差异。
