Callens Laura, Sienaert Pascal
From the KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium.
J ECT. 2024 Aug 26. doi: 10.1097/YCT.0000000000001063.
Posttraumatic stress disorder (PTSD) is associated with a high burden of disability and mortality. Despite standard treatments with antidepressants and/or psychotherapy, remission is often difficult to achieve. Electroconvulsive therapy (ECT) is an effective treatment for mood disorders but is currently not recognized as a treatment modality for PTSD. The literature about its potential role in the management of PTSD is growing. Thus, we aim to systematically review the available evidence for the role of ECT in PTSD.Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines, we performed a systematic literature search from 1958 to December 2023 using PubMed, Embase, Web of Science, Cochrane Central Register of Controlled trials databases, and the Clinicaltrials.gov-registry.Eighteen studies met our inclusion criteria: 1 meta-analysis, 2 randomized control trials, 2 prospective, 4 retrospective studies, 8 case reports, and 2 reviews.Accumulating evidence suggests that ECT might have a beneficial effect on the core symptoms of PTSD with comorbid conditions, such as depression or schizophrenia. Although in some studies, the effect on core PTSD symptoms was not related to an antidepressant effect of ECT, these findings need further replication. Nevertheless, in severe and intractable cases, ECT can be considered, especially in the presence of comorbid depression. Further research in patients without comorbidity is warranted.
创伤后应激障碍（PTSD）与高残疾负担和死亡率相关。尽管采用了抗抑郁药和/或心理治疗等标准治疗方法，但往往难以实现缓解。电休克治疗（ECT）是治疗情绪障碍的有效方法，但目前尚未被认可为PTSD的一种治疗方式。关于其在PTSD管理中潜在作用的文献正在不断增加。因此，我们旨在系统回顾ECT在PTSD中作用的现有证据。
我们遵循《系统评价和荟萃分析的首选报告项目2020》指南，使用PubMed、Embase、科学网、Cochrane对照试验中央注册数据库和Clinicaltrials.gov注册库，对1958年至2023年12月的文献进行了系统检索。
18项研究符合我们的纳入标准：1项荟萃分析、2项随机对照试验、2项前瞻性研究、4项回顾性研究、8例病例报告和2篇综述。
越来越多的证据表明，ECT可能对伴有抑郁症或精神分裂症等共病情况的PTSD核心症状有有益影响。尽管在一些研究中，ECT对PTSD核心症状的影响与ECT的抗抑郁作用无关，但这些发现需要进一步重复验证。然而，在严重且难治的病例中，可以考虑ECT，尤其是在存在共病抑郁症的情况下。对无共病患者进行进一步研究是有必要的。
