Lv Si-Wen, Sun Yan, Chen Yang, Wang Chen, Xie Xin-Hui, Hu Xiao-Min, Hong Hong, Zhang Lou-Feng, Zhu Nan-Nan, Xie Peng-Yv, Zhang Li, Chen Ling, Kong Xiao-Ming
Affiliated Psychological Hospital of Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei, China.
Department of Geriatric Endocrinology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
Psychiatry Investig. 2024 Jul;21(7):772-781. doi: 10.30773/pi.2023.0198. Epub 2024 Jul 24.
Patients with late life depression sometimes refuse to receive electroconvulsive therapy (ECT) owing to its adverse reactions. To alleviate patient's resistance, a novel ECT stimulation strategy named mixed-strategy ECT (msECT) was designed in which patients are administered conventional ECT during the first three sessions, followed by low energy stimulation during the subsequent sessions. However, whether low energy electrical stimulation in the subsequent stage of therapy affect its efficacy and reduce adverse reactions in patients with late life depression remains unknown. To explore differences between msECT and regular ECT(RECT) with respect to clinical efficacy and side effects.
This randomized, controlled trial was conducted from 2019 to 2021 on 60 patients with late life depression who were randomly assigned to two groups: RECT or msECT. A generalized estimating equation (GEE) was used to compare the two stimulation strategies regarding their efficacy and side effects on cognition. Chi-squared test was used to compare side effects in the two strategies.
In the intent-to-treat group, the GEE model suggested no differences between-group difference in Hamilton Depression Rating Scale-17 score over time (Wald χ2=7.275, p=0.064), whereas the comparison of side effects in the two strategies favored msECT (Wald χ2=8.463, p=0.015) as fewer patients had adverse events during the second phase of treatment with msECT (χ2 =13.467, p=0.004).
msECT presents its similar efficacy to RECT. msECT may have milder side effects on cognition.
老年抑郁症患者有时会因电休克治疗（ECT）的不良反应而拒绝接受该治疗。为减轻患者的抵触情绪，设计了一种名为混合策略ECT（msECT）的新型ECT刺激策略，即患者在前三个疗程接受常规ECT治疗，随后的疗程采用低能量刺激。然而，治疗后期的低能量电刺激是否会影响其疗效并减少老年抑郁症患者的不良反应尚不清楚。本研究旨在探讨msECT与常规ECT（RECT）在临床疗效和副作用方面的差异。
本随机对照试验于2019年至2021年对60例老年抑郁症患者进行，这些患者被随机分为两组：RECT组或msECT组。采用广义估计方程（GEE）比较两种刺激策略在疗效和认知副作用方面的差异。采用卡方检验比较两种策略的副作用。
在意向性治疗组中，GEE模型显示两组在汉密尔顿抑郁量表-17评分随时间的组间差异无统计学意义（Wald χ2=7.275，p=0.064），而两种策略的副作用比较显示msECT更具优势（Wald χ2=8.463，p=0.015），因为在msECT治疗的第二阶段发生不良事件的患者较少（χ2 =13.467，p=0.004）。
msECT与RECT疗效相似。msECT对认知的副作用可能较轻。
