French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand EA 7280, France.
French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Service de Psychiatrie et de Psychologie Médicale de l'adulte, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France.
J Affect Disord. 2020 Mar 1;264:318-323. doi: 10.1016/j.jad.2020.01.004. Epub 2020 Jan 7.
ECT is the most effective treatment of major depressive episode (MDE) but remains a neglected treatment. The French Society for Biological Psychiatry and Neuropsychopharmacology aimed to determine whether prescribing practice of ECT followed guidelines recommendations.
This multicenter, retrospective study included adult patients with major depressive disorder (MDD) or bipolar disorder (BD), who have been treated with ECT for MDE. Duration of MDE and number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests.
Seven hundred and forty-five individuals were included. The mean duration of MDE before ECT was 10.1 months and the mean number of lines of treatment before ECT was 3.4. It was significantly longer for MDD single episode than recurrent MDD and BD. The presence of first-line indications for using ECT was significantly associated to shorter duration of MDE (9.1 vs 13.1 months, p<0.001) and lower number of lines of treatment before ECT (3.3 vs 4.1, p<0.001).
This is a retrospective study and not all facilities practicing ECT participated that could limit the extrapolation of the results.
Compared to guidelines, ECT was not used as first-line strategy in clinical practice. The presence of first-line indications seemed to reduce the delay before ECT initiation. The improvements of knowledge and access of ECT are needed to decrease the gap between guidelines and clinical practice.
电抽搐治疗（ECT）是治疗重度抑郁发作（MDE）最有效的方法，但仍然是一种被忽视的治疗方法。法国生物精神病学和神经精神药理学学会旨在确定 ECT 的处方实践是否遵循指南建议。
这项多中心、回顾性研究纳入了接受 ECT 治疗 MDE 的成年单相或双相障碍患者。收集 MDE 的持续时间和 ECT 前接受的治疗线数。记录使用 ECT 的原因，特别是一线指征（自杀意念、紧迫性、出现紧张症和精神病特征、既往 ECT 反应、患者偏好）。使用标准统计检验对组间进行统计学比较。
共纳入 745 例患者。ECT 前 MDE 的平均持续时间为 10.1 个月，ECT 前的平均治疗线数为 3.4。单相 MDD 比复发性 MDD 和 BD 更长。使用 ECT 的一线指征与 MDE 持续时间较短（9.1 与 13.1 个月，p<0.001）和 ECT 前治疗线数较少（3.3 与 4.1，p<0.001）显著相关。
这是一项回顾性研究，并非所有实施 ECT 的医疗机构都参与，这可能会限制结果的推断。
与指南相比，ECT 在临床实践中并未作为一线策略使用。一线指征的存在似乎可以减少 ECT 开始前的延迟。需要提高对 ECT 的认识和获取途径，以缩小指南与临床实践之间的差距。
