目的:电惊厥治疗(ECT)是治疗情绪障碍最有效的治疗方法之一,主要发生在单相(MDD)或躁郁症(BD)背景下的重度抑郁发作(MDE)。然而,ECT仍然是一种被忽视和未充分利用的治疗方法。老年人是发生药物不良反应的高危患者。在这种情况下,我们试图根据是否存在国际指南提供的使用ECT的一线适应症,确定65岁或以上患者在开始ECT前的MDE持续时间和治疗行数.
方法:在这个多中心中,回顾性研究包括65岁或以上患有MDD或BD的MDE患者,这些患者已接受ECT治疗,收集有关MDE持续时间和ECT前接受治疗的行数的数据.使用ECT的原因,特别是一线适应症(自杀,紧迫性,存在紧张和精神病特征,以前的ECT反应,患者偏好)进行记录。组间的统计比较使用标准统计检验。
结果:我们确定了335例患者。在ECT之前MDE的平均持续时间约为9个月。BD明显短于MDD-约7个月和10个月,分别。在MDD组中,慢性医学疾病的共同发生增加了ECT前的持续时间。使用ECT指南的一线适应症的存在并没有减少ECT前MDE的持续时间,除了以前对ECT有反应的地方。一线适应症减少了开始ECT之前的治疗线数量。
结论:即使ECT由于其对MDE的有效性和安全性而似乎是老年人群的关键治疗方法,在这种治疗之前的延迟仍然太长了。
OBJECTIVE: Electroconvulsive therapy (ECT) is one of the most effective treatments in mood disorders, mainly in major depressive episode (MDE) in the context of either unipolar (MDD) or bipolar disorder (BD). However,
ECT remains a neglected and underused treatment. Older people are at high risk patients for the development of adverse drug reactions. In this context, we sought to determine the duration of MDEs and the number of lines of treatment before the initiation of ECT in patients aged 65 years or over according to the presence or absence of first-line indications for using ECT from international
guidelines.
METHODS: In this multicenter, retrospective study including patients aged 65 years or over with MDEs in MDD or BD who have been treated with ECT for MDEs, data on the duration of MDEs and the number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests.
RESULTS: We identified 335 patients. The mean duration of MDEs before
ECT was about 9 months. It was significantly shorter in BD than in MDD- about 7 and 10 months, respectively. The co-occurrence of chronic medical disease increased the duration before ECT in the MDD group. The presence of first-line indications for using
ECT from
guidelines did not reduce the duration of MDEs before
ECT, except where there was a previous response to
ECT. The first-line indications reduced the number of lines of treatment before starting ECT.
CONCLUSIONS: Even if ECT seems to be a key treatment in the elderly population due to its efficacity and safety for MDEs, the delay before this treatment is still too long.