Risikofaktoren für Rückfall nach Elektrokonvulsionstherapie bei depressiven Erkrankungen

Zusammenfassung

Ziel der Studie Eine wesentliche Herausforderung der Elektrokonvulsionstherapie (EKT) ist die Vermeidung von Rückfällen nach erfolgreicher Akutbehandlung. Hierfür wird zunehmend das Konzept der langsam ausschleichenden Erhaltungs-EKT propagiert. Das Ziel dieser Untersuchung war es, Risikofaktoren für Rückfälle nach EKT bei depressiven Erkrankungen zu identifizieren.

Methodik Nach erfolgreicher Akutbehandlung einer depressiven Episode mit EKT wurde allen Patienten Erhaltungs-EKT nach einem festen Schema angeboten. Tatsächlich variierte die Anzahl der E-EKTs aufgrund unterschiedlicher Compliance im naturalistischen Setting. Alle Patienten mit einer Verlaufskontrolle von mindestens 6 Monaten wurden in der retrospektiven Analyse berücksichtigt (n = 82). Überlebensanalysen mit der Zeit bis zum Rückfall als abhängige Variable wurden benutzt, um den Einfluss der Risikofaktoren auf das Rückfallrisiko einzuschätzen.

Ergebnisse 34,1 % der Patienten erlitten innerhalb von 6 Monaten einen Rückfall. Mit einem verminderten Rückfallrisiko assoziiert waren 1. Erhaltungs-EKT, besonders innerhalb der ersten 3 Monate, 2. erhöhte durchschnittliche Ladung während der Indexserie, 3. Wechsel der Elektrodenposition von unilateral auf bilateral während der Indexserie und 4. männliches Geschlecht. Die Sensitivitätsanalyse weist darauf hin, dass das geringere Rückfallrisiko von Männern gegenüber Frauen insbesondere in den ersten 3 Monaten besteht.

Schlussfolgerung Erwartungsgemäß war Erhaltungs-EKT mit einer reduzierten Rückfallrate assoziiert, insbesondere die frühen Behandlungen nach der Indexserie. Daneben wurde ein Zusammenhang eines verminderten Rückfallrisikos mit einer höheren Ladung sowie dem Wechsel zu einer bilateralen Elektrodenposition während der Indexserie gefunden. Bei Frauen traten frühe Rückfälle vermehrt auf.

Abstract

Background Maintaining remission after successful acute treatment remains a challenge in the use of electroconvulsive therapy (ECT). For this purpose, the concept of gradually tapered continuation ECT (C-ECT) has been increasingly propagated. The present study is aimed at identifying factors that contribute to relapse after ECT in depressed patients.

Methods After successful acute treatment of a depressive episode with ECT, all patients were offered a fixed schedule of C-ECT. The number of C-ECT sessions varied in this naturalistic setting depending on compliance. All patients with follow-up data of at least 6 months were included (n = 82). Survival analyses with time to relapse as dependent variable were used to estimate the risk of relapse.

Results 34.1 % of the patients relapsed within 6 months. Factors associated with a decreased relapse rate were: 1. C-ECT treatment, especially within the first three month; 2. higher mean charge during I-ECT; 3. switch from unilateral to bilateral electrode placement during I-ECT, and 4. male sex. However, the sensitivity analyses suggest that the influence of sex on relapse was limited to the first three months of the continuation phase.

Conclusion As expected, C-ECT reduced relapse rates, especially when performed early after I-ECT. Besides, increased charge and a change of electrode placement from unilateral to bilateral during the index series were associated with a lower risk of relapse. Compared to men, there was a higher rate of relapse in women.

Schlüsselwörter

behandlungsresistente Depression - Elektrokonvulsionstherapie - Rückfall - Elektrodenplatzierung

Key words

electroconvulsive therapy - relapse - charge - electrode placement - Treatment-resistant depression

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