Maintenance Electroconvulsive Therapy

Yıl 2010, Cilt: 2 Sayı: 4, 421 - 442, 01.12.2010

Mustafa Melih Bilgi Çağdaş Eker Ali Saffet Gönül

Öz

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.

Anahtar Kelimeler

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

• Tang WK, Ungvari GS. Continuation and maintenance electroconvulsive therapy: a selective review of the literature. Hong Kong J Psychiatry 1999; 9:6-12.
• Andrade C, Kurinji S. Continuation and maintenance ECT: A review of recent research. J ECT 2002; 18:149-158.
• Prudic J, Olfson M, Sackeim HA. Electro-convulsive therapy practices in the community. Psychol Med 2001; 31:929–934.
• American Psychiatric Association. The Practice of ECT: Recommendations for Practice, Training, and Privileging. Task Force Report on ECT. Washington, DC, American Psychiatric Press, 1990.
• American Psychiatric Association Committee on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging, 2nd ed. Washington, DC, American Psychiatric Association, 2001.
• Royal College of Psychiatrists’ Special Committee on ECT. The ECT Handbook, 2nd ed. London, UK, The Royal College of Psychiatrists, 2005.
• National Institute for Clinical Excellence. Guidance on the Use of Electroconvulsive Therapy (Technology Appraisal 59). London, UK, National Institute for Clinical Excellence, 2003.
• Steffens DC, Krystal AD, Sibert TE, Moore SD, Weiner RD. Cost effectiveness of maintenance ECT. Convuls Ther 1995; 11:283-284.
• Bonds C, Frye MA, Coudreaut MF, Cunningham M, Spearing M, McGuire M et al. Cost reduction with maintenance ECT in refractory bipolar disorder. J ECT 1998; 14:36-41.
• McDonald WM, Phillips VL, Figiel GS, Marsteller FA, Simpson CD, Bailey MC. Cost- effective maintenance treatment of resistant geriatric depression. Psychiatr Ann 1998; 28:47-52.
• Aziz M, Mehringer AM, Mozurkewich E, Razik GN. Cost-utility of 2 maintenance treatments for older adults with depression who responded to a course of electro- convulsive therapy: results from a decision analytic model. Can J Psychiatry 2005; 50:389-397.
• Moss L E, Vaidya N A. Electroconvulsive therapy as an alternative treatment for obese patients with mood disorders. J ECT 2006; 22:223-225.
• Wijkstra J, Nolen WA, Algra A, van Vliet IM, Kahn RS. Relapse prevention in major depressive disorder after successful ECT: a literature review and a naturalistic case series. Acta Psychiatr Scand 2000: 102:454-460.
• Shimizu E, Imai M, Fujisaki M, Shinoda N, Handa S, Watanabe H et al. Maintenance ECT for treatment resistant disorganized schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:571-573.
• Consoli A, Boulicot V, Cornic F, Fossati P, Barbeau M, Cohen D. Moderate clinical improvement with maintenance ECT in a 17-year-old boy with intractable catatonic schizophrenia. Eur Child Adolesc Psychiatry 2009; 18:250-254.
• Fink M. Convulsive therapy: a review of the first 55 years. J Affect Disord 2001; 63:1- 15.
• Jarvis MR, Zorumski CF, Goewert AJ, Rasmussen KG. Maintenance electroconvulsive therapy and seizure duration. Convuls Ther 1993; 9:8-13.
• Francis A, Fochtmann L. Sustained downregulation of cortical adrenergic receptor density with maintenance electroconvulsive stimulation. Convuls Ther 1993; 9:185- 191.
• Fochtmann LJ. Animal studies of electroconvulsive therapy: foundations for future research. Psychopharmacol Bull 1994; 30:321-444.
• Andrade C, Sudha S. Electroconvulsive therapy and the alpha-2 noradrenergic receptor: implications of treatment schedule effects. J ECT 2000; 16:268-278.
• Seethalakashmi R, Parkar S R, Nair N, Pandit A G. Increased Thalamostriatal- Mesiotemporal Glucose Uptake with symptom remission in schizophrenia. J ECT 2006; 22:74-75.
• Tomruk NB, Oral T. Elektrokonvulsif tedavinin klinik kullanımı: Bir gözden geçirme. Anadolu Psikiyatri Dergisi 2007; 8:302-309.
• Frederikse M, Petrides G, Kellner C. Continuation and maintenance electroconvulsive therapy for the treatment of depressive illness: a response to the National Institute for Clinical Excellence Report. J ECT 2006; 22:13-17.
• Chanpattana W, Andrade C. ECT for treatment-resistant schizophrenia: A response from the Far East to the UK. NICE Report. J ECT 2006; 22:4-12.
• Tielkes C E M, Comijs H C, Verwijk E, Stek M L. The effects of ECT on cognitive functioning in the elderly: a review. Int J Geriatr Psychiatry 2008; 23:789-795.
• Wahlund B, von Rosen D. ECT of major depressed patients in relation to biological and clinical variables: a brief overview. Neuropsychopharmacology. 2003; 28(Suppl 1):S21-S26.
• Sackeim HA, Devanand DP, Prudic J. Stimulus intensity, seizure threshold, and seizure duration: Impact on the efficacy and safety of electroconvulsive therapy. Psychiatr Clin North Am 1991; 14:803-843.
• Sanacora G, Mason GF, Rothman DL, Hyder F, Ciarcia JJ, Ostroff RB et al. Increased cortical GABA concentrations in depressed patients receiving ECT. Am J Psychiatry. 2003; 160:577-579.
• Mervaala E, Kononen M, Fohr J, Husso-Saastamoinen M, Valkonen-Korhonen M, Kuikka JT et al. SPECT and neuropsychological performance in severe depression treated with ECT. J Affect Disord 2001; 66:47-58.
• Palmio J, Huuhka M, Saransaari P, Oja SS, Peltola J, Leinonen E et al. Changes in plasma amino acids after electroconvulsive therapy of depressed patients. Psychiatry Res 2005; 137:183-190.
• Balu DT, Hoshaw BA, Malberg JE, Rosenzweig-Lipson S, Schechter LE, Lucki I. Differential regulation of central BDNF protein levels by antidepressant and non- antidepressant drug treatments. Brain Res 2008; 1211:37-43. 32. Eker C, Ovali GY, Ozan E, Eker OD, Kitis O,
• Coburn K et al. Prog
• Neuropsychopharmacol Biol Psychiatry 2008; 32:1628-1632.
• Grunhaus L, Zelnik T, Albala AA, Rabin D, Haskett RF, Zis AP et al. Serial dexamethasone suppression tests in depressed patients treated only with electroconvulsive therapy. J Affect Disord 1987; 13:233-240.
• Maayan R, Yagorowski Y, Grupper D, Weiss M, Shtaif B, Kaoud MA et al. Basal plasma dehydroepiandrosterone sulfate level: a possible predictor for response to electroconvulsive therapy in depressed psychotic inpatients. Biol Psychiatry 2000; 48:693-701.
• Baghai TC, Möller HJ. Electroconvulsive therapy and its different indications. Dialogues Clin Neurosci 2008; 10:105-117.
• Consensus Devolopment Panel. Mood disorders: pharmacologic prevention of recurrences. Am J Psychiatry 1985; 142:469-476.
• Calabrese JR, Suppes T, Bowden CL, Sachs GS, Swann AC, McElroy SL et al. A double- blind, placebo controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder: Lamictal 614 Study Group. J Clin Psychiatry 2000;61:841-850.
• Kendler KS, Thornton LM, Gardner CO. Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the ‘kindling‘ hypothesis. Am J Psychiatry 2000; 157:1243-1251.
• Kendler KS, Thornton LM, Gardner CO. Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression. Am J Psychiatry 2001;158:582–586.
• Vanelle J-M, Loo H, Galinowski A, de Carvalho W, Bourdel MC, Brochier P et al. Maintenance ECT in intractable manic-depressive disorders. Convuls Ther 1994; 10:195-205.
• Gagne GG, Furman MJ, Carpenter LL, Price LH. Efficacy of continuation ECT and antidepressant drugs compared with long-term antidepressants alone in depressed patients. Am J Psychiatry 2000; 157:1960-1965.
• Jaffe R, Dubin W, Shoyer B, Roemer R, Sharon D, Lipschutz L. Outpatient electroconvulsive therapy: efficacy and safety. Convuls Ther 1990; 6:231-238.
• Dubin WR, Jaffe R, Roemer R, Siegel L, Shoyer B, Venditti ML. The efficacy and safety of maintenance ECT in geriatric patients. J Am Geriatr Soc 1992; 40:706-709.
• Puri BK, Langa A, Coleman RM, Singh I. The clinical efficacy of maintenance electroconvulsive therapy in a patient with a mild mental handicap. Br J Psychiatry 1992; 161:707-709.
• Petrides G, Dhossche D, Fink M, Francis A. Continuation ECT: Relapse prevention in affective disorders. Convuls Ther 1994; 10:189-194.
• Fox HA. Extended continuation and maintenance ECT for long-lasting episodes of major depression. J ECT 2001; 17:60-64.
• Kramer BA. A naturalistic review of maintenance ECT at a university setting. J ECT 1999; 15:262-269.
• Swoboda E, Conca A, Konig P, Waanders R, Hansen M. Maintenance electroconvulsive therapy in affective and schizoaffective disorder. Neuropsychobiology 2001; 43:23-28.
• Chanpattana W. Combined ECT and clozapine in treatment-resistant mania. J ECT 2000; 16:204-207.
• Gupta S, Tobiansky R, Bassett P, Warner J. Efficacy of maintenance electroconvulsive therapy in recurrent depression: A naturalistic study. J ECT 2008; 24:191-194.
• Clarke TB, Coffey CE, Hoffman GW, Weiner RD. Continuation therapy for depression using outpatient electroconvulsive therapy. Convuls Ther 1989; 5:330-337.
• McDonald WM, Thompson TR, Okun L, Beyer K, Holtzheimer PE, Woodard JL. Post- ECT continuation and maintenance. J ECT 2005; 21:54-55.
• Russell JC, Rasmussen KG, O'Connor MK, Copeman CA, Ryan DA, Rummans TA. Long-term maintenance ECT: A retrospective review of efficacy and cognitive outcome. J ECT. 2003; 19:4-9.
• Monroe RE. Maintenance electroconvulsive therapy. Psychiatr Clin North Am 1991; 14:947-960.
• Bozkurt A, Karlidere T, Isintas M, Ozmenler NK, Ozsahin A, Yanarates O. Acute and maintenance electroconvulsive therapy for treatment of psychotic depression in a pregnant patient. J ECT 2007; 23:185-187.
• Jaffe RL, Rives W, Dubin WR, Roemer RA, Siegel L. Problems in maintenance ECT in bipolar disorder: Replacement by lithium and anticonvulsants. Convuls Ther 1991; 7:288-294.
• Schwarz T, Loewenstein J, Isenberg K E. Maintenance ECT: Indications and outcome. Convuls Ther 1995; 11:14-23.
• Kellner CH, Knapp RG, Petrides G, Rummans TA, Husain MM, Rasmussen K et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression. Arch Gen Psychiatry 2006; 63:1337-1344.
• Srinivasan TN, Suresh TR, Jayaram V. Issues in the use of maintenance electroconvulsive therapy. Indian J Psychiatry 1995; 37:139-142.
• Rasmussen KG. Clinical applications of recent research of ECT. Bull Menninger Clin 2003; 67:18-31.
• Kellner CH, Burns CM, Bernstein HJ, Monroe RR. Electrode placement in maintenance electroconvulsive therapy. Convuls Ther 1991; 7:61-62.
• Navarro V, Gasto´ C, Torres X Masana G, Penadés R, Guarch J et al. Continuation/maintenance treatment with nortriptyline versus combined nortriptyline and ECT in late-life psychotic depression: A two-year randomized study. Am J Geriatr Psychiatry 2008; 16:498-505.
• Fink M. Efficacy of ECT. Lancet. 1979; 2:1303-1304.
• Kales HC, Dequardo JR, Tandon R. Combined electroconvulsive therapy and clozapine in treatment-resistant schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 1999; 23:547-556.
• Havaki-Kontaxaki BJ, Ferentinos PP, Kontaxakis VP, Paplos KG, Soldatos CR. Concurrent administration of clozapine and electroconvulsive therapy in clozapine- resistant schizophrenia. Clin Neuropharmacol 2006; 29:52-56.
• Chanpattana W, Chakrabhand MLS, Sackeim HA, Kitaroonchai W, Kongsakon R, Techakasem P et al. Continuation ECT in treatment-resistant schizophrenia: a controlled study. J ECT 1999; 15:129-139.
• Chanpattana W, Chakrabhand ML. Factors influencing treatment frequency of continuation ECT in schizophrenia. J ECT 2001; 17:190-194.
• Chanpattana W. Maintenance ECT in mentally retarded, treatment resistant schizophrenic patients. J ECT 1999;15:150-153.
• Thuppal M, Fink M. Electroconvulsive therapy and mental retardation. J ECT 1999; 15:140-149.
• Casey DA, Davis MH. Obsessive-compulsive disorder responsive to electroconvulsive therapy in an elderly woman. South Med J 1994; 87:862-864.
• Husain MM, Lewis SF, Thornton WL. Maintenance ECT for refractory obsessive- compulsive disorder. Am J Psychiatry 1993; 150:1899-1900.
• Shulman R. Maintenance ECT in the treatment of PD. Geriatrics 2003; 58:43-45.
• Gandaghar BN, Kapur RL. Comparison of electroconvulsive therapy with imipramine in endogenous depression: a double-blind study. Br J Psychiatry 1982; 141:367-371.
• Sackeim HA, Portnoy S, Neeley P, Steif BL, Decina P, Malitz S. Cognitive consequences of low-dosage electroconvulsive therapy. Ann NY Acad Sci 1986; 462:326-340.
• Hill GE, Wong KC, Hodges MR. Lithium carbonate and neuromuscular blocking agents. Anesthesiology 1977; 46:122-126.
• Reimherr FW, Hodges MR, Hill GE, Wong KC. Prolongation of muscle relaxant effects by lithium carbonate. Am J Psychiatry 1977; 134:205-206.
• Krystal AD, Coffey CE. Neuropsychiatric considerations in the use of electroconvulsive therapy. J Neuropsychiatry Clin Neurosci 1997; 9:283-292.
• Devanand DP, Sackeim HA, Prudic J. Electroconvulsive therapy in the treatment- resistant patient. Psychiatr Clin N Am 1991; 14:905-923.
• Husain MM, Rush AJ, Fink M, Knapp R, Petrides G, Rummans T et al. Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report. J Clin Psychiatry 2004; 65:485-491.
• Ghaziuddin N, Laughrin D, Giordani B. Cognitive side effects of electroconvulsive therapy in adolescents. J Child Adolesc Psychopharmacol 2000; 10:269-276.
• Datto CJ, Levy S, Miller DS, Katz IR. Impact of maintenance ECT on concentration and memory. J ECT 2001; 17:170-174.
• Grunhaus L, Pande AC, Haskett RF. Full and abbreviated courses of maintenance electroconvulsive therapy. Convuls Ther 1990; 6:130-138.
• Rami-Gonzalez L, Salamero M, Boget T, Catalan R, Ferrer J, Bernardo M. Pattern of cognitive dysfunction in depressive patients during maintenance electroconvulsive therapy. Psychol Med 2003; 33:345-350.
• Abraham G, Milev R, Delva N, Zaheer J. Clinical outcome and memory function with maintenance electroconvulsive therapy: A retrospective study. J ECT 2006; 22:43-45.
• Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology 2007; 32:244-254.
• Sackeim HA. The convulsant and anticonvulsant properties of electroconvulsive therapy: towards a focal form of brain stimulation. Clin Neurosci 2004; 4:39-57.