Maintenance Electroconvulsive Therapy

Abstract

Since the other treatment options did not meet the expectations in treatment resistant patients, maintenance electroconvulsive therapy (m-ECT) recently regained interest as a treatment option . Although it has long been applied as a treatment, studies of m-ECT lacks strong evidence for effectiveness, safety and the choice of application method because of problems regarding methodology, small sample sizes and scarcity of randomized, double-blind, controlled trials. Besides several points about treatment remains uncertain. Some of these troubled points are the selection of patients that will receive m-ECT, schedule and procedure of the application, the duration of the treatment, the assessment and follow-up of side effects and concomitant medication with drugs. Therefore, some guidelines recommended it for a particular group of patients and some rejected its application with a cautious consideration. The terminology, applications and rationales in different disorders, possible side effects and concomitant drug use are discussed in this review. Further studies with broader samples are needed to clarify the issues of effectiveness and adverse events in m-ECT.

Keywords

• Maintenance ECT, Mood Disorders, Schizophrenia, Cognitive Side Effects

İdame Elektrokonvulzif Tedavi

Öz

İdame Elektrokonvülzif Tedavi (idame EKT), tedaviye dirençli bazı hastalarda kullanılan diğer tedavi seçeneklerinin bekleneni verememesi nedeniyle son dönemde yeniden yıldızı parlayan bir tedavi seçeneğidir. Uzun süredir kullanılan bir tedavi olmasına rağmen yapılan çalışmaların yöntemsel sorunları, örneklem yetersizliği, rastgele çift-kör kontrollü olanların azlığı nedeniyle etkinliği, güvenilirliği, uygulama şekliyle ilgili sağlam kanıtlar elde edilememiştir. Bunun yanında tedaviyle ilgili çeşitli konularda standart yaklaşımlar net olarak belirlenememiştir. Bu konulardan bazıları tedavi görecek hasta grubunun belirlenmesi, uygulama takvimi-şekli, tedavinin ne kadar süreceği, yan etkilerin neler olduğu-nasıl izlenmesi gerektiği, birlikte ilaç kullanımıdır. Bu nedenle bazı tedavi yönergelerinde belirli bir grup hastaya önerilen, bazılarında temkinli yaklaşımla tamamen reddedilen bir tedavi olmuştur. Bu yazıda konuyla ilgili terminoloji, farklı hastalıklarda kullanımı ve rasyoneli, olası yan etkileri, birlikte psikotrop kullanımı gibi konular kaynaklardan taranarak ele alınmıştır. İdame EKT'nin etkililik ve yan etkileri bakımından daha iyi bilgi verebilecek geniş örneklemli çalışmalara gereksinim bulunmaktadır.

Anahtar Kelimeler

• İdame EKT, Duygudurum Bozuklukları, Şizofreni, Bilişsel Yan Etkiler

Kaynakça

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