后续治疗延长了抑郁症治疗益处

2001年3月16日纽约，2001年3月16日 - 一种良好的治疗方法，耐药抑郁症，电压治疗，在随访时，随着组合药物治疗时，对哥伦比亚研究员的研究表明，一项研究表达了更持久的益处。该研究发表于3月14日美国医学协会期刊。电流疗法（ECT），其中电流通过大脑，被认为是安全有效地治疗严重抑郁的，特别是那些拒绝吃的人的自杀者，或者没有受益于药物的人。美国的其他程序程序数量超过冠状动脉旁路，阑尾切除术或疝气修复。在1900年代中期，不分青红皂白地使用ECT给它一个黑暗的声誉，举例说明了1975件薄膜，“一只飞过杜鹃鸟巢。”今天使用的ECT使用经过精心控制，专家们提倡提升耻辱的裹尸布并围绕手术恐惧。同一问题的社论讨论了这个问题。然而，ECT治疗的一个缺点是许多患者在六个月内复发到抑郁症状。在20世纪60年代，发现药物可以在许多患者中预防这一点，但这些药物对目前接受ECT的患者的类型是值得怀疑的。20世纪90年代的研究在很大程度上在哥伦比亚进行，发现复发是一个问题比在哥伦比亚精神病学和放射学的临床心理学教授，哈罗德A. Sackeim所说，复发是一个问题。 Dr. Sackeim, who is also chief of biological psychiatry at the New York State Psychiatric Institute, led the new study. It found that a combination drug follow-up treatment leads to a markedly lower relapse rate. The new treatment consists of lithium -- a drug often used to help prevent or reduce mood swings -- and nortriptyline, one of an important class of drugs called tricyclic antidepressants. Tricyclic antidepressants alone have been commonly used to help prevent relapse, but the new study suggests the combination therapy works better. The study compared patients who took the combination treatment, nortriptyline alone, and a placebo. Nortriptyline-lithium combination therapy had a marked advantage in time to relapse, superior to both placebo and nortriptyline alone, the authors wrote. Over the 24-week trial, the relapse rate for placebo was 84 percent; for nortriptyline, 60 percent; and for nortriptyline-lithium, 39 percent. Investigators at Columbia designed and monitored the project. It was conducted from 1993 to 1998 at the Carrier Foundation, Belle Meade, N.J., and at two university-based psychiatric facilities at the University of Iowa, Iowa City, and Western Psychiatric Institute and Clinic, Pittsburgh. The idea for nortriptyline-lithium therapy came from the fact that it has been successfully used to treat acute depression resistant to other treatments, Dr. Sackeim said. The authors say two other strategies should be tested to further improve relapse rates. These approaches are meant to provide more therapeutic protection to patients during a crucial five-to-six week period, typically right after ECT therapy, when they are most vulnerable to relapse. One strategy is to taper ECT over a few weeks, as is commonly done with pharmacological treatments, providing symptom suppression during the most vulnerable period. Second, the antidepressant medication used in continuation therapy may be started during the course of ECT, followed by post-ECT addition of lithium, they write. The National Institute of Mental Health has funded a large trial to test these strategies, Dr. Sackeim said. In an editorial in the same issue of the JAMA, Deputy Editor Richard M. Glass, M.D., discusses the new research in the context of ECT's history and the need to give the procedure more public acceptance. For the sake of the many patients with major depression and their families, it is time to bring ECT out of the shadows, he concludes. The results of ECT in treating severe depression are among the most positive treatment effects in all of medicine, Dr. Glass also writes. ECT has had response rates reported in the range of 80 percent to 90 percent as a first-line treatment, and in the range of 50 percent to 60 percent for patients who have not responded to one or more trials of treatment with antidepressant drugs. The new study on combination follow-up therapy was supported by the National Institute of Mental Health, Solvay Pharmaceuticals Inc. (which donated the lithium), and MECTA Corp. (which provided the ECT devices.)

####