Department of Psychiatry, Providence Care Hospital, Queen's University, Kingston, ON, Canada.
Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
Acta Psychiatr Scand. 2019 Mar;139(3):214-226. doi: 10.1111/acps.12994. Epub 2018 Dec 16.
In this systematic review and meta-analysis, the response, remission, and speed of response in adults with major depressive disorder (MDD) and bipolar disorder in depressive episode (BDD) receiving an acute course of electroconvulsive therapy (ECT) were quantitatively analyzed.
Using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 1660 citations were identified through five electronic databases. Nineteen articles met final inclusion criteria for meta-analysis.
The pooled response and remission rates with ECT in MDD were 74.2% (n = 1246/1680) and 52.3% (n = 850/1626), respectively. In BDD, they were 77.1% (n = 437/567) and 52.3% (n = 275/377), respectively. Although response rates to ECT were statistically higher in BDD (OR = 0.73, 95% CI: 0.56-0.95, P = 0.02), remission rates were similar (OR = 0.91, 95% CI: 0.65-1.26, P = 0.56). Individuals with BDD vs. MDD required fewer number of ECT sessions to achieve response (SMD = -0.23, 95% CI: -0.44 to -0.023, P = 0.03). There were no significant moderator effects identified.
Response rates and speed of response are higher in individuals with BDD; however, remission rates are equivalent. These findings support increased utilization of ECT in individuals with treatment-refractory BDD.
在这项系统评价和荟萃分析中，我们定量分析了接受急性电抽搐治疗（ECT）的成年重性抑郁障碍（MDD）和伴有抑郁发作的双相障碍（BDD）患者的反应率、缓解率和反应速度。
我们使用系统评价和荟萃分析首选报告项目的指南，通过五个电子数据库确定了 1660 个引用。19 篇文章最终符合荟萃分析的纳入标准。
MDD 患者接受 ECT 的总体反应率和缓解率分别为 74.2%（n = 1246/1680）和 52.3%（n = 850/1626）。BDD 患者的反应率和缓解率分别为 77.1%（n = 437/567）和 52.3%（n = 275/377）。尽管 BDD 患者的 ECT 反应率在统计学上更高（OR = 0.73，95%CI：0.56-0.95，P = 0.02），但缓解率相似（OR = 0.91，95%CI：0.65-1.26，P = 0.56）。与 MDD 相比，BDD 患者需要更少的 ECT 疗程即可达到反应（SMD = -0.23，95%CI：-0.44 至 -0.023，P = 0.03）。未发现显著的调节效应。
BDD 患者的反应率和反应速度较高；然而，缓解率相当。这些发现支持在治疗抵抗性 BDD 患者中增加 ECT 的应用。
