Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Acta Psychiatr Scand. 2020 Aug;142(2):121-131. doi: 10.1111/acps.13183. Epub 2020 Jun 8.
Electroconvulsive therapy (ECT) is commonly used to treat patients with treatment-resistant depression. We aimed to investigate whether combining an antidepressant agent with ECT might enhance therapeutic efficacy and prevent early relapse.
During the acute ECT phase, patients (N = 97) with treatment-resistant depression were randomized to receive ECT plus agomelatine 50 mg/day (n = 48) or ECT plus placebo (n = 49). Symptom severity measures, including the 17-item Hamilton Depression Rating Scale (HAMD-17) and other scales, functional impairment, quality of life, neuropsychological tests, adverse events and attitudes toward ECT, were assessed regularly. Remission was defined as a HAMD-17 score ≤7. If patients achieved post-ECT remission, they were prescribed agomelatine 50 mg/day and participated in a 12-week follow-up trial. HAMD-17 was rated at 4-week intervals. Relapse was defined as a HAMD-17 score ≥14, or rehospitalization for a psychiatric reason.
The two treatment groups were comparable at (i) baseline variables; (ii) score changes in all symptom measures, functional impairment, quality of life, and neuropsychological tests; (iii) frequency of adverse events and attitudes toward ECT; and (iv) post-ECT response/remission rates. There were no statistically significant differences following ECT in relapse rates and time to relapse between these two groups.
Adding agomelatine to ECT yielded comparable response/remission rates to ECT without agomelatine in the acute ECT phase. Starting agomelatine in combination with ECT did not seem to be more efficacious in preventing relapse than starting agomelatine after the acute ECT course. More research is needed to guide clinical recommendations.
电抽搐治疗（ECT）常用于治疗治疗抵抗性抑郁症患者。我们旨在研究抗抑郁药物联合 ECT 是否可以增强疗效并预防早期复发。
在急性 ECT 阶段，治疗抵抗性抑郁症患者（N=97）被随机分为 ECT 联合阿莫沙平 50mg/天组（n=48）或 ECT 联合安慰剂组（n=49）。定期评估症状严重程度，包括 17 项汉密尔顿抑郁量表（HAMD-17）和其他量表、功能障碍、生活质量、神经心理学测试、不良反应和对 ECT 的态度。缓解定义为 HAMD-17 评分≤7。如果患者在 ECT 后达到缓解，他们将被处方阿莫沙平 50mg/天，并参加为期 12 周的随访试验。4 周评估一次 HAMD-17。复发定义为 HAMD-17 评分≥14，或因精神原因再次住院。
两组治疗组在（i）基线变量；（ii）所有症状、功能障碍、生活质量和神经心理学测试评分变化；（iii）不良反应和对 ECT 的态度的频率；（iv）ECT 后的反应/缓解率方面相似。两组之间 ECT 后复发率和复发时间没有统计学差异。
在急性 ECT 阶段，在 ECT 中加入阿莫沙平并未显著提高 ECT 的反应/缓解率。与急性 ECT 疗程后开始使用阿莫沙平相比，在开始 ECT 时联合使用阿莫沙平似乎并没有更有效地预防复发。需要进一步研究以指导临床建议。
