The benefits and costs of changing treatment technique in electroconvulsive therapy due to insufficient improvement of a major depressive episode |
| |
Affiliation: | 1. Department of Psychiatry, Columbia University, NY, USA;2. Department of Radiology, Columbia University, NY, USA;3. New York State Psychiatric Institute, NY, USA;4. Department of Neurology, Columbia University, NY, USA;5. Department of Psychiatry & Behavioral Sciences, New York Medical College, NY, USA;6. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA;7. Department of Psychiatry, University of Toronto, Toronto, ON, Canada;8. Centre for Addiction and Mental Health, Toronto, ON, Canada;9. Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA |
| |
Abstract: | BackgroundElectroconvulsive therapy (ECT) technique is often changed after insufficient improvement, yet there has been little research on switching strategies.ObjectiveTo document clinical outcome in ECT nonresponders who were received a second course using high dose, brief pulse, bifrontotemporal (HD BP BL) ECT, and compare relapse rates and cognitive effects relative to patients who received only one ECT course and as a function of the type of ECT first received.MethodsPatients were classified as receiving Weak, Strong, or HD BP BL ECT during three randomized trials at Columbia University. Nonresponders received HD BP BL ECT. In a separate multi-site trial, Optimization of ECT, patients were randomized to right unilateral or BL ECT and nonresponders also received further treatment with HD BP BL ECT.ResultsRemission rates with a second course of HD BP BL ECT were high in ECT nonresponders, approximately 60% and 40% in the Columbia University and Optimization of ECT studies, respectively. Clinical outcome was independent of the type of ECT first received. A second course with HD BP BL ECT resulted in greater retrograde amnesia immediately, two months, and six months following ECT.ConclusionsIn the largest samples of ECT nonresponders studied to date, a second course of ECT had marked antidepressant effects. Since the therapeutic effects were independent of the technique first administered, it is possible that many patients may benefit simply from longer courses of ECT. Randomized trials are needed to determine whether, when, and how to change treatment technique in ECT. |
| |
Keywords: | Electroconvulsive therapy (ECT) Switching strategy Relapse Retrograde amnesia BF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" bifrontal BL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" bifrontotemporal or bilateral BP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" brief pulse ECT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" electroconvulsive therapy EEG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" electroencephalogram HD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" high dose HRSD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" Hamilton Rating Scale for Depression RCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" randomized controlled trial (RCT) RUL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" right unilateral ST" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," _" :" seizure threshold UB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" ultrabrief pulse |
本文献已被 ScienceDirect 等数据库收录! |
|