Kelsey M C, Grossberg G T
Department of Psychiatry, St. Louis University Health Sciences Center, Missouri, USA.
J Geriatr Psychiatry Neurol. 1995 Jul;8(3):168-72. doi: 10.1177/089198879500800305.
Prior studies have shown that in younger depressives undergoing ECT whose seizure durations declined despite maximum settings on three different ECT devices, pretreatment with caffeine lengthened seizures and resulted in clinical improvement. Caffeine (half life, 140-270 minutes) was well tolerated even in patients with pre-existing cardiovascular disease. The purpose of this retrospective study was to determine the safety and efficacy of caffeine augmented ECT in elderly depressed patients. The charts of 14 elderly depressives (average age 75.6, range 59-83; 2 males, 12 females) who received caffeine-augmented ECT were reviewed. Patients pre- and post-ECT medications, blood pressure, pulse, and seizure times (cuff and EEG) for each ECT performed were noted. The following conclusions were drawn from our study: (1) Caffeine definitely increases the seizure length and was useful in our setting when the energy settings could not be increased anymore. (2) Caffeine augmentation inconsistently causes an increase in pulse rate, on average, in the elderly. (3) Caffeine inconsistently produces an increase in mean arterial pressure. (4) Caffeine did not consistently produce an increase in the maximum rate-pressure product. We conclude from this study that caffeine-augmented ECT is safe and effective in increasing seizure duration in the elderly. However, more research needs to be done to determine optimal dosing and tolerability.
先前的研究表明，在接受电休克治疗（ECT）的年轻抑郁症患者中，尽管三种不同的ECT设备已设置到最大参数，但他们的癫痫发作持续时间仍在缩短，而在治疗前使用咖啡因可延长发作时间并带来临床改善。即使是患有心血管疾病的患者，对咖啡因（半衰期为140 - 270分钟）的耐受性也良好。这项回顾性研究的目的是确定咖啡因增强ECT在老年抑郁症患者中的安全性和有效性。我们回顾了14例接受咖啡因增强ECT治疗的老年抑郁症患者（平均年龄75.6岁，范围59 - 83岁；2名男性，12名女性）的病历。记录了患者在每次ECT治疗前后的用药情况、血压、脉搏以及癫痫发作时间（袖带法和脑电图记录）。我们的研究得出了以下结论：（1）咖啡因确实能延长癫痫发作时长，在能量设置无法再提高的情况下对我们的研究对象很有用。（2）咖啡因增强治疗在老年人中平均而言不一致地导致脉搏率增加。（3）咖啡因不一致地导致平均动脉压升高。（4）咖啡因并非始终会使最大率压乘积增加。我们从这项研究得出结论，咖啡因增强ECT在增加老年人癫痫发作持续时间方面是安全有效的。然而，需要进行更多研究以确定最佳剂量和耐受性。
