From the Department of Psychiatry, Weill Medical College of Cornell University and New York Presbyterian Hospital, Westchester Division, White Plains, NY.
University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA.
J Clin Psychopharmacol. 2021;41(2):196-199. doi: 10.1097/JCP.0000000000001354.
PURPOSE/BACKGROUND: Electroconvulsive therapy (ECT) is effective in the treatment of acute episodes of psychotic depression. However, no adequately powered studies have directly investigated the efficacy of antipsychotic pharmacotherapy in relapse prevention of psychotic depression after ECT. In the absence of such literature, we reviewed the clinical practice of 4 academic medical centers that have made research contributions in the treatment of psychotic depression over the past 20 years.
METHODS/PROCEDURES: We reviewed medical records of patients with a diagnosis of psychotic depression who received 1 or more acute courses of ECT over the span of 3 years. Chi-square tests were used to compare pharmacotherapy prescribed at the time of completion of ECT.
FINDINGS/RESULTS: A total of 163 patients received 176 courses of ECT for separate episodes of psychotic depression. The combination of an antidepressant plus an antipsychotic was the most common regimen, ranging from 61.9% to 85.5% of all prescriptions. One center added lithium in 45.5% of cases treated with the combination of an antidepressant plus an antipsychotic. An antipsychotic alone was prescribed in less than 10% of cases. An antidepressant alone or other drug combinations were rare.
IMPLICATIONS/CONCLUSIONS: The combination of an antidepressant plus an antipsychotic was the most commonly prescribed regimen at the completion of ECT for relapse prevention in patients with psychotic depression acutely treated with ECT. Although this report offers a view of the clinical practice of 4 academic medical centers, it also points to the need of randomized controlled trials on continuation pharmacotherapy after treatment of psychotic depression with ECT.
目的/背景：电痉挛疗法（ECT）在治疗精神病性抑郁症的急性发作中是有效的。然而，没有足够大的研究直接调查抗精神病药物治疗在 ECT 后预防精神病性抑郁症复发的疗效。在缺乏这种文献的情况下，我们回顾了 4 个学术医疗中心的临床实践，这些中心在过去 20 年里在治疗精神病性抑郁症方面做出了研究贡献。
方法/程序：我们回顾了在 3 年内接受过 1 次或多次急性 ECT 治疗的精神病性抑郁症患者的病历。采用卡方检验比较 ECT 完成时开的药物治疗。
结果/发现：共有 163 名患者因不同的精神病性抑郁症发作接受了 176 次 ECT。抗抑郁药加抗精神病药的联合治疗是最常见的方案，占所有处方的 61.9%至 85.5%。在使用抗抑郁药加抗精神病药联合治疗的病例中，有 45.5%的病例加用了锂。单独使用抗精神病药的病例不到 10%。单独使用抗抑郁药或其他药物联合治疗的情况很少见。
意义/结论：在接受 ECT 治疗的精神病性抑郁症患者中，ECT 结束时预防复发最常开的处方是抗抑郁药加抗精神病药联合治疗。虽然这份报告提供了 4 个学术医疗中心的临床实践观点，但它也指出了在 ECT 治疗精神病性抑郁症后进行继续药物治疗的随机对照试验的必要性。
