Wagenmakers Margot J, Oudega Mardien L, Bouckaert Filip, Rhebergen Didi, Beekman Aartjan T F, Veltman Dick J, Sienaert Pascal, van Exel Eric, Dols Annemieke
GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands.
J Clin Psychiatry. 2022 Aug 10;83(5):21m14287. doi: 10.4088/JCP.21m14287.
Electroconvulsive therapy (ECT) is a safe and effective treatment, especially in psychotic late-life depression (LLD). However, it is not yet clear whether the greater efficacy seen in psychotic LLD is because of a shorter index episode duration. The first aim of this study was to substantiate the superior ECT remission rates in patients with psychotic LLD, as compared to patients with nonpsychotic LLD, and a second aim was to investigate whether this association is independent of the index duration. 186 patients with LLD treated with ECT were included in the study: 76 from the Valerius cohort (data collection from 2001 to 2006) and 110 from the Mood Disorders Treated with Electroconvulsive Therapy (MODECT) cohort (data collection from 2011 to 2013). The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate depression severity, with remission defined as 2 consecutive MADRS scores < 10. Diagnosis of depression was based on (Valerius) and (MODECT) criteria. A stepwise logistic regression model was built to assess the association between psychotic symptoms, index duration, and remission. Patients with psychotic LLD showed significantly higher remission rates compared to patients with nonpsychotic LLD (68.9% vs 51.0%), independent of index duration, additionally corrected for age, sex, and baseline depression severity (OR = 2.10 [95% CI, 1.07-4.10], = .03). Patients with psychotic LLD treated with ECT show higher remission rates compared to patients with nonpsychotic LLD. The high remission rates in patients with psychotic LLD are not explained by a shorter index duration. Future studies focusing on neurobiological differences in psychotic versus nonpsychotic depression may indicate why this subtype of depression is very responsive to ECT. ClinicalTrials.gov identifier: NCT02667353.
电休克治疗（ECT）是一种安全有效的治疗方法，尤其适用于老年期精神病性抑郁症（LLD）。然而，目前尚不清楚在精神病性LLD中观察到的更高疗效是否归因于较短的首发发作持续时间。本研究的首要目的是证实与非精神病性LLD患者相比，精神病性LLD患者的ECT缓解率更高，第二个目的是研究这种关联是否独立于首发持续时间。186例接受ECT治疗的LLD患者纳入本研究：76例来自瓦勒里乌斯队列（2001年至2006年数据收集），110例来自电休克治疗情绪障碍（MODECT）队列（2011年至2013年数据收集）。采用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）评估抑郁严重程度，缓解定义为连续两次MADRS评分<10。抑郁症诊断基于（瓦勒里乌斯）和（MODECT）标准。建立逐步逻辑回归模型以评估精神病性症状、首发持续时间和缓解之间的关联。与非精神病性LLD患者相比，精神病性LLD患者的缓解率显著更高（68.9%对51.0%），独立于首发持续时间，另外校正了年龄、性别和基线抑郁严重程度（OR = 2.10 [95% CI，1.07 - 4.10]，P = 0.03）。与非精神病性LLD患者相比，接受ECT治疗的精神病性LLD患者缓解率更高。精神病性LLD患者的高缓解率不能用较短的首发持续时间来解释。未来针对精神病性与非精神病性抑郁症神经生物学差异的研究可能会揭示为什么这种抑郁症亚型对ECT反应非常敏感。ClinicalTrials.gov标识符：NCT02667353。
