Psykiatri Nordväst, Stockholm County Council. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council. Centrum för psykiatriforskning, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden.
Faculty of Medicine and Health, Örebro University.
J Affect Disord. 2019 Dec 1;259:296-301. doi: 10.1016/j.jad.2019.08.064. Epub 2019 Aug 20.
Electroconvulsive therapy (ECT) is an effective treatment for depression, but there is risk of cognitive adverse events. This risk has been partially attributed to electrical charge, thus the optimal electrical stimulus dose is still under discussion. The aim of this study was to evaluate how the risk of subjective memory worsening was changed after lowering stimulus dose during ECT for patients with major depression.
A retrospective register-based intervention study of the effects of reduced electrical charges for patients receiving ECT for depression was conducted. The primary outcome was subjective memory worsening and the secondary outcome change in effect on depressive symptoms.
A total of 154 patients were enrolled in the study (High dosage group: n = 57; Lower dosage group: n = 97). Subjective memory worsening after ECT occurred in 44% of patients in the high dosage group and in 25% of patients in the lower dosage group(p = 0.014). There was no significant between-group difference in the anti-depressive effect of ECT.
The study was register-based and the two groups were not randomized. A large portion of patients were initially excluded due to missing data in the register. The study lacks a long-term follow up.
After implementing a change of treatment protocol, that lowered ECT stimulus doses from high to moderate, the occurrence of subjective memory worsening was significantly reduced without compromising treatment results.
电痉挛疗法（ECT）是治疗抑郁症的有效方法，但存在认知不良事件的风险。这种风险部分归因于电荷，因此最佳电刺激剂量仍在讨论中。本研究旨在评估在降低电痉挛治疗抑郁症患者的刺激剂量后，主观记忆恶化的风险如何变化。
这是一项回顾性基于登记的干预研究，评估了降低电痉挛治疗抑郁症患者的电刺激剂量对患者的影响。主要结局是主观记忆恶化，次要结局是抑郁症状改善的变化。
共有 154 名患者入组研究（高剂量组：n=57；低剂量组：n=97）。在高剂量组中，44%的患者在 ECT 后出现主观记忆恶化，而在低剂量组中，这一比例为 25%（p=0.014）。两组之间 ECT 的抗抑郁效果没有显著差异。
该研究基于登记数据，且两组未进行随机分组。由于登记数据中存在缺失，很大一部分患者最初被排除在外。研究缺乏长期随访。
在实施治疗方案改变，即从高剂量到中剂量降低 ECT 刺激剂量后，主观记忆恶化的发生显著减少，而治疗结果不受影响。
