阈下改良电休克治疗抑郁症的疗效和安全性评估

Evaluation of efficacy and safety about sub-threshold modified electroconvulsive therapy for depression

目的评估20%和40%电量的阈下低电量改良电休克治疗(modified electroconvulsive therapy,MECT)对抑郁症的疗效和安全性。方法本研究为随机对照研究;根据Excel中RAND程序制定随机数字表,对符合DSM-Ⅳ抑郁症诊断标准的108例患者分为20%电量组、40%电量组、80%电量组(对照组),每组36例;3组均给予MECT治疗8次,第1周每日1次,治疗5次;第2周隔日1次,治疗3次;访视点分别为基线、首次治疗后4~8 h内、末次治疗后4~8 h内及治疗开始后的第4周、第8周。分别采用HAMD17、重复成套神经心理状态测验(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)评估患者抑郁症状和认知功能,采用重复测量方差分析和单因素方差分析进行统计比较。结果(1)HAMD17(F=10.769,P<0.05)和RBANS(F=6.961,P<0.05)得分组间主效应均有统计学意义。(2)HAMD17(F=3.450,P<0.05)和RBANS(F=2.501,P<0.05)得分时间×电量分组交互作用均有统计学意义。(3)末次治疗后(F=3.673,P<0.05)、4周(F=4.570,P<0.05)、8周(F=4.122,P<0.05)HAMD17得分组间效应均有统计学意义,20%与40%电量组比较有统计学意义(P<0.05),20%及40%电量组与对照组比较均无统计学意义(P>0.05)。(4)末次治疗后,RBANS得分(F=7.890,P<0.05)组间效应有统计学意义,20%电量组[(65.2±12.2)分]、40%电量组[(63.9±11.5)分]与对照组[(55.2±11.2)分]比较差异均有统计学意义(P<0.05);而8周时RBANS得分(F=2.770,P>0.05)组间效应无统计学意义。结论40%电量MECT治疗抑郁症与标准电量相比疗效无差异,20%电量与标准电量相比疗效差,但认知功能损伤均较轻。

Objective This study was aimed to evaluate the short-term antidepressive effect and the cognitive decline of the acute modified electroconvulsive therapy(MECT)course with 20%and 40%sub-threshold electricity stimulus dose in patients suffered with major depressive disorder.Methods A total of 108 patients who met the DSM-Ⅳcriteria of depression were enrolled and,according to the RAND procedure in excel,were randomly assigned into 3 groups:20%electricity group,40%electricity group,and 80%electricity group(control),with 36 cases each accordingly.All patients were given one 8 times MECT with consecutively 5 times in the first week followed by intermittently 3 times in the second week(once every the other day).Depression symptoms(assessed by HAMD17)and the cognitive function(assessed by the Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)were evaluated at baseline,4 to 8 hours after the first treatment,4 to 8 hours after the last treatment,the end of the week-4 and the week-8.The results were compared by repeated measurement analysis of variance and one-way analysis of variance(ANOVA).Results(1)There were significant differences in HAMD17(F=10.769,P<0.05)and RBANS(F=6.961,P<0.05)among the three groups.(2)The time×electricity group interactions of HAMD17(F=3.450,P<0.05)and RBANS(F=2.501,P<0.05)scoring were of statistical significance.(3)The scores of HAMD17 after the last treatment(F=3.673,P<0.05),at week-4(F=4.570,P<0.05),and week-8(F=4.122,P<0.05)presented with significant difference among the three groups.There was no significant difference between either group and the control(P>0.05).However,there was significant difference in HAMD17 between the 20%electricity group and the 40%electricity group(P<0.05).(4)After the last treatment of MECT,the scores of RBANS among all three groups were significantly different(F=7.890,P<0.05).And compared to the control(55.2±11.2),the cognitive level measured by RBANS scores was relatively preserved in 20%(65.2±12.2)and 40%(63.9±11.5)electricity groups(P<0.05).At week-8,the scores of RBANS(F=2.770,P>0.05)were not significantly different among the three groups.Conclusion Subthreshold MECT with the stimulus dose at 40%electricity seems not much different in antidepressive efficacy from the standard electricity dose,and the adverse impact on the cognitive function is relatively less.The efficacy of the 20%electricity dose is poor though the cognitive decline is also minimal.