Mukhtar Fahad, Regenold William, Lisanby Sarah H
Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
Fac Rev. 2023 Jun 7;12:13. doi: 10.12703/r/12-13. eCollection 2023.
Electroconvulsive therapy (ECT), the oldest somatic therapy still in use in psychiatry today, remains one of the most effective therapeutic interventions for a wide variety of psychiatric disorders. In this article, we review some of the recent advances in ECT that are currently being researched and implemented in clinical practice. We explore recent studies that point to the potential therapeutic benefit and safety of ECT in COVID-19-related neuropsychiatric complications and special populations (such as the elderly and pregnant persons) that are generally at higher risk of having adverse effects from psychotropic medications. We highlight studies that performed a head-to-head comparison of ECT and ketamine, which has shown promise for treatment-resistant depression and acute suicidality. Researchers continue to explore different ways of using ECT by modifying the treatment parameters to maintain efficacy and decrease side effects. Neurocognitive side effects remain one of the major drawbacks to its use and contribute to the negative stigma of this highly effective treatment. In this regard, we describe attempts to improve the safety of ECT by modifying dosing parameters, novel electrode placements, and the addition of augmenting agents with the aim of decreasing side effects and improving efficacy. This review identifies some of the recent advances in the last few years in ECT research while also highlighting areas where further research is needed.
电休克疗法（ECT）是当今精神病学中仍在使用的最古老的躯体疗法，仍然是治疗多种精神疾病最有效的治疗干预措施之一。在本文中，我们回顾了ECT的一些最新进展，这些进展目前正在临床实践中进行研究和应用。我们探讨了近期的研究，这些研究指出了ECT在与COVID-19相关的神经精神并发症以及通常因精神药物产生不良反应风险较高的特殊人群（如老年人和孕妇）中的潜在治疗益处和安全性。我们重点介绍了对ECT和氯胺酮进行直接比较的研究，氯胺酮已显示出对难治性抑郁症和急性自杀倾向有治疗前景。研究人员继续探索通过修改治疗参数来使用ECT的不同方法，以维持疗效并减少副作用。神经认知副作用仍然是其使用的主要缺点之一，并导致这种高效治疗方法背负负面污名。在这方面，我们描述了通过修改给药参数、采用新型电极放置以及添加增效剂来提高ECT安全性的尝试，目的是减少副作用并提高疗效。本综述确定了近年来ECT研究的一些最新进展，同时也突出了需要进一步研究的领域。
