Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.
Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.
J Neurol Sci. 2022 Mar 15;434:120095. doi: 10.1016/j.jns.2021.120095. Epub 2021 Dec 18.
Electroconvulsive therapy (ECT) is a treatment modality for patients with treatment resistant depression (TRD), defined as failure of two adequate antidepressant medication trials. We provide a qualitative review of ECT's effectiveness for TRD, methods to optimize ECT parameters to improve remission rates and side effect profiles, and ECT's proposed neurobiological mechanisms. Right unilateral (RUL) electrode placement has been shown to be as effective for major depression as bilateral ECT, and RUL is associated with fewer cognitive side effects. There is mixed evidence on how to utilize ECT to sustain remission (i.e., continuation ECT, psychotropic medications alone, or a combination of ECT and psychotropic medications). Related to neurobiological mechanisms, an increase in gray matter volume in the hippocampus-amygdala complex is reported post-ECT. High connectivity between the subgenual anterior cingulate and the middle temporal gyrus before ECT is associated with better treatment response. Rodent models have implicated changes in neurotransmitters including glutamate, GABA, serotonin, and dopamine in ECT's efficacy; however, findings in humans are limited. Altogether, while ECT remains a highly effective therapy, the neurobiological underpinnings associated with improvement of depression remain uncertain.
电抽搐治疗（ECT）是一种治疗难治性抑郁症（TRD）的方法，定义为两种充分的抗抑郁药物试验失败。我们提供了对 ECT 治疗 TRD 的有效性、优化 ECT 参数以提高缓解率和副作用特征的方法以及 ECT 提出的神经生物学机制的定性综述。与双侧 ECT 相比，右侧单侧（RUL）电极放置已被证明对重度抑郁症同样有效，并且 RUL 与较少的认知副作用相关。关于如何利用 ECT 维持缓解（即继续 ECT、单独使用精神药物或 ECT 和精神药物联合使用）存在混合证据。与神经生物学机制有关，据报道，ECT 后海马-杏仁核复合体的灰质体积增加。ECT 前扣带回下前部和中颞叶之间的高连通性与更好的治疗反应相关。啮齿动物模型表明，包括谷氨酸、GABA、血清素和多巴胺在内的神经递质的变化与 ECT 的疗效有关；然而，在人类中的发现是有限的。总的来说，虽然 ECT 仍然是一种非常有效的治疗方法，但与抑郁症改善相关的神经生物学基础仍不确定。
