Gurel S Can, Mutlu Emre, Başar Koray, Yazıcı M Kazım
Department of Psychiatry, Hacettepe University Medical Faculty, Turkey; Brain Stimulation and Cognition Group, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
Ministry of Health, Sehit Sait Erturk Etimesgut State Hospital, Turkey.
Asian J Psychiatr. 2021 Jan;55:102503. doi: 10.1016/j.ajp.2020.102503. Epub 2020 Nov 30.
Although electroconvulsive therapy (ECT) has been extensively used for depressive episodes in bipolar disorder (BDD), it has received less interest in research compared with major depressive disorder (MDD). Studies comparing the efficacy of ECT in BDD and MDD have been contradictory. This study aimed to compare the effectiveness of ECT in BDD and MDD, analyzing the influence of clinical features on outcome.
The medical charts and electronic records of 107 patients (MDDn = 75 [70.1 %], BDD n = 32 [29.9 %]) receiving bi-temporal ECT were investigated retrospectively. Features of the index episode, such as the time elapsed until ECT and the effect of diagnosis on efficacy evaluated by the Hamilton Depression Rating Scale (HAM-D), were analyzed.
The diagnostic groups were alike concerning clinical features of the index episode, such as the presence of psychotic symptoms and suicidality. Patient age and the number of previous affective episodes were significantly different between the groups. The time elapsed until ECT in the examined episode was significantly longer in the MDD group. Compared with the MDD group, the BDD group had a significantly higher remission rate with ECT. Regression analysis revealed that BDD diagnosis, older age, and shorter time until ECT were significantly associated with remission.
The significant relationship observed between greater time elapsed until ECT and worse outcome is noteworthy in terms of clinical practice. This finding further challenges the widely accepted place of ECT as the "last resort" for the treatment of depression in bipolar and unipolar affective disorders.
尽管电休克疗法（ECT）已广泛用于双相情感障碍（BDD）的抑郁发作，但与重度抑郁症（MDD）相比，它在研究中受到的关注较少。比较ECT在BDD和MDD中疗效的研究结果相互矛盾。本研究旨在比较ECT在BDD和MDD中的有效性，分析临床特征对治疗结果的影响。
回顾性调查了107例接受双侧ECT治疗的患者（MDD组75例[70.1%]，BDD组32例[29.9%]）的病历和电子记录。分析了首次发作的特征，如ECT治疗前的病程以及通过汉密尔顿抑郁量表（HAM-D）评估的诊断对疗效的影响。
在首次发作的临床特征方面，如精神病性症状和自杀观念的存在，诊断组之间相似。两组患者的年龄和既往情感发作次数存在显著差异。MDD组在本次发作中至ECT治疗的病程明显更长。与MDD组相比，BDD组接受ECT治疗后的缓解率显著更高。回归分析显示，BDD诊断、年龄较大以及至ECT治疗的时间较短与缓解显著相关。
就临床实践而言，ECT治疗前病程越长与治疗效果越差之间的显著关系值得关注。这一发现进一步挑战了ECT作为双相和单相情感障碍抑郁症治疗“最后手段”这一被广泛接受的地位。
