Pluijms Esther M, Vinther Poul T, Kamperman Astrid M, Birkenhäger Tom K
Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Department of Intensive Home Treatment, Antes Psychiatric Institute (part of Parnassia Group), Rotterdam, the Netherlands.
Acta Psychiatr Scand. 2023 Jun;147(6):561-569. doi: 10.1111/acps.13542. Epub 2023 Mar 30.
High relapse rates are observed after electroconvulsive therapy (ECT) for major depression. Identifying patients who are at increased risk for relapse to intensify their treatment regimen post-ECT might reduce relapse rates. We aimed to determine clinical characteristics that are associated with relapse within 2 years after successful ECT.
Patients who remitted to ECT in a randomised controlled trial comparing adjuvant nortriptyline and placebo during a course of bilateral ECT were followed-up prospectively for 1 year with open-label nortriptyline (Dutch Trial Register NTR5579). Second-year follow-up data were collected retrospectively. Thirty-four patients were included in this follow-up cohort. To examine the association between clinical characteristics and the risk of relapse, unadjusted hazard ratios (HRs) were calculated.
At 2 years post-ECT, the overall relapse rate was 50%, and the HRs for relapse in patients with psychotic features, a higher severity of depression, and medication resistance prior to ECT were 0.33 (CI 0.12-0.89; p = 0.029), 0.88 (CI 0.80-0.98; p = 0.014), and 4.48 (CI 1.28-15.73, p = 0.019), respectively. No effect was found for age, sex or episode duration on the relapse rate.
Depressed patients with psychotic features, with higher symptom severity and without medication resistance prior to ECT have a significantly decreased risk of relapse after successful ECT. A sustained remission rate of 50% over 2 years in patients with severe major depression who were treated with nortriptyline monotherapy after successful ECT is encouraging.
在对重度抑郁症进行电休克治疗（ECT）后，观察到较高的复发率。识别复发风险增加的患者，以加强其ECT后的治疗方案，可能会降低复发率。我们旨在确定与ECT成功后2年内复发相关的临床特征。
在一项随机对照试验中，对双侧ECT疗程中辅助使用去甲替林和安慰剂进行比较的患者进行ECT缓解后，使用开放标签的去甲替林进行了为期1年的前瞻性随访（荷兰试验注册NTR5579）。回顾性收集了第二年的随访数据。该随访队列纳入了34名患者。为了检查临床特征与复发风险之间的关联，计算了未调整的风险比（HRs）。
在ECT后2年，总体复发率为50%，有精神病性特征、抑郁严重程度较高以及ECT前药物抵抗的患者复发的HRs分别为0.33（CI 0.12 - 0.89；p = 0.029）、0.88（CI 0.80 - 0.98；p = 0.014）和4.48（CI 1.28 - 15.73，p = 0.019）。未发现年龄、性别或发作持续时间对复发率有影响。
有精神病性特征、症状严重程度较高且ECT前无药物抵抗的抑郁症患者，在ECT成功后复发风险显著降低。在ECT成功后接受去甲替林单药治疗的重度抑郁症患者中，2年内持续缓解率达到50%，这令人鼓舞。
