Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Acta Psychiatr Scand. 2023 Apr;147(4):322-332. doi: 10.1111/acps.13537. Epub 2023 Feb 20.
Electroconvulsive therapy (ECT) is an effective treatment for severe depressive symptoms, yet more research is needed to examine predictors of treatment response, and factors associated with response in patients not initially improving with treatment. This study reports factors associated with time to response (early vs. late) to ECT in a real-world setting.
This was a retrospective, single-center cohort study of patients endorsing moderate to severe depressive symptoms using the Quick Inventory of Depressive Symptomatology (QIDS; QIDS>10). Response was defined as 50% or greater decrease in QIDS score from baseline. We used logistic regression to predict response at treatment #5 (early response) as well as after treatment #5 (late response) and followed patients through ECT discontinuation or through treatment #20.
Of the 1699 patients included in this study, 555 patients (32.7%) responded to ECT treatment at treatment #5 and 397 (23.4%) responded after treatment #5. Among patients who did not respond by treatment #5, those who switched to brief pulse width ECT from ultrabrief pulse ECT had increased odds of response after treatment #5 compared with patients only receiving ultrabrief pulse (aOR = 1.55, 95% CI: 1.16-2.07). Additionally, patients with less improvement in QIDS from baseline to treatment #5 had decreased odds of response after treatment #5 (aOR = 0.97, 95% CI = 0.97-0.98).
Among depressed patients treated with ECT, response occurred in 56.0% of patients by treatment #20. Patient receiving ultrabrief pulse ECT at baseline and who did not respond by treatment #5 had greater odds of subsequent response if switched to brief pulse ECT than if continued with ultrabrief pulse.
电抽搐疗法（ECT）是治疗严重抑郁症状的有效方法，但仍需要更多研究来检查治疗反应的预测因素，以及与初始治疗无改善的患者反应相关的因素。本研究报告了在真实环境中与 ECT 反应时间（早期与晚期）相关的因素。
这是一项回顾性、单中心队列研究，纳入了使用贝克抑郁自评量表（BDI）或快速抑郁症状评定量表（QIDS）评定为中重度抑郁症状的患者（BDI 或 QIDS>10）。反应定义为 QIDS 评分较基线下降 50%或更多。我们使用逻辑回归来预测治疗第 5 天（早期反应）以及治疗第 5 天以后（晚期反应）的反应，并对患者进行 ECT 停止或治疗第 20 天的随访。
在这项研究中，共纳入了 1699 例患者，其中 555 例（32.7%）在治疗第 5 天对 ECT 治疗有反应，397 例（23.4%）在治疗第 5 天以后有反应。在治疗第 5 天没有反应的患者中，与仅接受 ultrabrief 脉冲的患者相比，从 ultrabrief 脉冲切换到 brief 脉冲宽度的患者在治疗第 5 天以后有更高的反应可能性（OR=1.55，95%CI：1.16-2.07）。此外，从基线到治疗第 5 天 QIDS 评分改善较少的患者在治疗第 5 天以后反应的可能性降低（OR=0.97，95%CI=0.97-0.98）。
在接受 ECT 治疗的抑郁患者中，到治疗第 20 天，56.0%的患者有反应。在基线时接受 ultrabrief 脉冲 ECT 治疗且在治疗第 5 天无反应的患者，如果切换到 brief 脉冲 ECT，比继续使用 ultrabrief 脉冲 ECT 有更高的后续反应可能性。
