Devanand D P, Fitzsimons L, Prudic J, Sackeim H A
New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, USA.
Convuls Ther. 1995 Dec;11(4):232-40.
In 92 depressed patients who were randomized to unilateral or bilateral electroconvulsive therapy (ECT) at either low dosage (just above seizure threshold) or high dosage (2.5 times the seizure threshold), subjective side effects were assessed with the Columbia ECT Subjective Side Effects Schedule. A research nurse administered the instrument 4 h after each treatment during the ECT course. In 41 patients, the instrument was also administered before the ECT course. Headache, disorientation, and memory complaints were the most common subjective side effects during the ECT course. Somatic side effects did not change from early to late in the ECT course, and were not influenced by ECT electrode placement or dosage. Most individual somatic side effects, including nausea, tiredness, and muscle aches/pains did not change from pre-ECT to during the ECT course, and may have been a function of the persistent somatic symptoms of depression. Cognitive complaints increased from pre-ECT to during the ECT course, but there was no overall change from pre-ECT to immediately after the ECT course. Cognitive complaints were greater with bilateral compared with unilateral ECT, with no significant effect of electrical dosage. During the ECT course, subjective mood improved and psychomotor agitation decreased, particularly in clinical responders. These findings suggest that most putative somatic side effects are related to the depressive state rather than being induced by ECT. The observed changes reinforce the need to evaluate both subjective and objective side effects during ECT.
92名抑郁症患者被随机分为接受低剂量（略高于癫痫阈值）或高剂量（癫痫阈值的2.5倍）的单侧或双侧电休克治疗（ECT），使用哥伦比亚ECT主观副作用量表评估主观副作用。在ECT疗程中，每次治疗后4小时由一名研究护士使用该量表。41名患者在ECT疗程开始前也使用了该量表。头痛、定向障碍和记忆问题是ECT疗程中最常见的主观副作用。躯体副作用在ECT疗程早期到晚期没有变化，且不受ECT电极放置或剂量的影响。大多数个体躯体副作用，包括恶心、疲倦和肌肉酸痛，从ECT疗程前到疗程中没有变化，可能是抑郁症持续躯体症状的一种表现。认知问题从ECT疗程前到疗程中有所增加，但从ECT疗程前到疗程结束后即刻没有总体变化。与单侧ECT相比，双侧ECT的认知问题更严重，电剂量没有显著影响。在ECT疗程中，主观情绪改善，精神运动性激越减少，尤其是在临床反应者中。这些发现表明，大多数假定的躯体副作用与抑郁状态有关，而非由ECT诱发。观察到的变化强化了在ECT期间评估主观和客观副作用的必要性。
