Sauvaget Anne, Bulteau Samuel, Galvao Filipe, Szekely David, Fossati Philippe, Poulet Emmanuel
Association Française de Psychiatrie Biologique et de Neuropsychopharmacologie (AFPBN), STEP Section (Stimulation transcrânienne en psychiatrie), Saint-Germain-en-Laye, France; Nantes Université, CHU Nantes, Movement, Interactions, Performance, MIP, UR 4334, 44000 Nantes, France.
Association Française de Psychiatrie Biologique et de Neuropsychopharmacologie (AFPBN), STEP Section (Stimulation transcrânienne en psychiatrie), Saint-Germain-en-Laye, France; CHU Nantes, Department of Addictology and Liaison Psychiatry, Inserm-U1246 SPHERE University of Nantes and University of Tours, Nantes, France; UMR 1246 SPHERE, University of Nantes, University of Tours, INSERM, Nantes, France; CHU Nantes, Department of Addictology and Psychiatry, 44000 Nantes, France.
Encephale. 2023 Feb;49(1):103-106. doi: 10.1016/j.encep.2022.05.002. Epub 2022 Aug 13.
At a time when innovations in psychiatry are booming, particularly in the field of medical devices, we thought it necessary, as members of French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), to reconsider one of the oldest medical devices in psychiatry: the ECT apparatus. First, we recall the regulatory aspects of ECT. National guidelines define means of implementation and conditions of administration of ECT. Second, we remind of the indications and levels of evidence of ECT in the main psychiatric disorders, including catatonia. Then, we synthetize the place of ECT alongside other brain stimulation therapies, especially repetitive Trancranial Magnetic Stimulation (rTMS). Furthermore, we explain the general effects of ECT: increased neuronal plasticity and neurogenesis, enhancement of the stress axis, resistance to oxidative stress, improved vascular endothelial function, activation of microglia and astrocytes, decrease in inflammatory events by upregulation of neuroinflammatory cytokines, and production of mitochondrial ATP. These effects appear from the first sessions and continue during the course of ECT treatment, suggesting activation of endogenous neuroprotection. Finally, we remember that most patients perform as well or better on neuropsychological assessments after ECT, relative to pre-ECT results, and this improvement continues over the following months. Memory disorders reported post-ECT are not all attributable to ECT. They may be subjective in nature or linked to residual depressive (and possibly comorbid neurogenerative) symptoms later attributed to ECT, on the basis of preexisting negative representations. We urgently need to reemphasize the crucial role of ECT in psychiatric treatment strategies as well as the need to update ECT recommendations.
在精神病学创新蓬勃发展的时代，尤其是在医疗设备领域，作为法国生物精神病学和神经精神药理学协会（AFPBN）的成员，我们认为有必要重新审视精神病学中最古老的医疗设备之一：ECT 仪器。首先，我们回顾一下 ECT 的监管方面。国家指南规定了 ECT 的实施方式和给药条件。其次，我们提醒大家注意 ECT 在主要精神疾病（包括紧张症）中的适应症和证据水平。然后，我们综合阐述了 ECT 在其他脑刺激疗法（尤其是重复经颅磁刺激（rTMS））中的地位。此外，我们解释了 ECT 的一般作用：增强神经元可塑性和神经发生、增强应激轴、抵抗氧化应激、改善血管内皮功能、激活小胶质细胞和星形胶质细胞、通过上调神经炎症细胞因子减少炎症事件以及产生线粒体 ATP。这些作用从最初的疗程就开始显现，并在 ECT 治疗过程中持续存在，这表明内源性神经保护作用被激活。最后，我们记得，与 ECT 治疗前的结果相比，大多数患者在接受 ECT 后的神经心理学评估中表现相同或更好，而且这种改善在接下来的几个月中持续存在。ECT 后报告的记忆障碍并非都归因于 ECT。它们可能本质上是主观的，或者与后来归因于 ECT 的残留抑郁（以及可能合并的神经退行性）症状有关，这些症状基于先前存在的负面认知。我们迫切需要重新强调 ECT 在精神治疗策略中的关键作用，以及更新 ECT 建议的必要性。
