Parnassia Psychiatric Institute, The Hague, The Netherlands.
Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Psychology, Amsterdam Unversity Medical Center, Amsterdam, The Netherlands.
J Affect Disord. 2020 Jul 1;272:501-507. doi: 10.1016/j.jad.2020.03.134. Epub 2020 Apr 29.
Depressive disorder causes significant suffering in patients and caregivers worldwide. Electroconvulsive therapy (ECT) is a highly effective antidepressant treatment, but little is known about the prognosis and treatment of patients who do not achieve remission with ECT. We investigated prognosis and treatment of patients with major depression who did not achieve remission after 12 unilateral electroconvulsive therapy sessions.
We conducted a retrospective, naturalistic follow-up study. Patients who had previously participated in a double-blind randomized controlled trial that compared brief pulse with ultra-brief pulse ECT and who had not achieved remission after 12 right unilateral (RUL) ECT sessions were selected for this study. We analysed the type of treatments received during the 6-month follow-up and studied the occurrence of remission and response. The primary outcome was remission, defined as a Montgomery-Åsberg Depression Rating Scale score <10.
Eighty-one patients were randomized, of which 18 patients did not remit. Eight of these non-remitters achieved remission during follow-up (44.4%) while 7 did not achieve remission (38.9%). Remission data could not be retrieved for 3 patients (16.7%). Remission was achieved in 6 patients by a combination of continuing unilateral ECT with antidepressants or switching to bilateral ECT.
This is a retrospective study with only a small number of patients. Treatment after RUL ECT non-remission was not standardized.
When patients with major depression do not achieve remission after 12 RUL ECT sessions, they have still a reasonable chance of remission within 6 months. Continuing ECT has the best chance of success.
抑郁障碍在全球范围内给患者和照护者带来了巨大的痛苦。电抽搐治疗（ECT）是一种非常有效的抗抑郁治疗方法，但对于 ECT 治疗后未缓解的患者的预后和治疗知之甚少。我们调查了 12 次单侧 ECT 治疗后未缓解的重度抑郁症患者的预后和治疗情况。
我们进行了一项回顾性、自然主义的随访研究。选择先前参加过一项比较短脉冲与超短脉冲 ECT 的双盲随机对照试验且 12 次右侧单侧 ECT（RUL）治疗后未缓解的患者进行此项研究。我们分析了 6 个月随访期间接受的治疗类型，并研究了缓解和反应的发生情况。主要结局是缓解，定义为蒙哥马利-阿斯伯格抑郁评定量表（MADRS）评分<10。
81 名患者被随机分配，其中 18 名患者未缓解。这 18 名非缓解者中有 8 名在随访期间缓解（44.4%），7 名未缓解（38.9%）。3 名患者（16.7%）的缓解数据无法检索。6 名患者通过继续单侧 ECT 联合抗抑郁药或转换为双侧 ECT 达到缓解。
这是一项回顾性研究，患者数量较少。RUL ECT 无缓解后的治疗未标准化。
当重度抑郁症患者在 12 次 RUL ECT 治疗后未缓解时，他们在 6 个月内仍有合理的缓解机会。继续 ECT 治疗的成功机会最大。
