Aktuelles zur Elektrokrampftherapie bei schweren depressiven Störungen

Zusammenfassung

Trotz neuer Antidepressiva und Stimmungsstabilisierer respondieren zumindest 10% der Patienten mit schweren rezidivierenden Depressionen nicht ausreichend auf eine Pharmakotherapie oder vertragen keine ausreichenden Dosierungen. Obwohl laut Metaanalysen und systematischen Übersichtsarbeiten die Elektrokrampftherapie (EKT) die wirksamste Behandlung schwerer depressiver Störungen ist, werden in Deutschland nur wenige Patienten so behandelt. Diese Übersicht berichtet Neues zur Effizienz und zu somatischen und kognitiven Nebenwirkungen der rechtslateralen (hochdosierten), der bitemporalen und bifrontalen EKT. Im direkten Vergleich ist die EKT wirksamer als die repetitive transkranielle Magnetstimulation (rTMS). Die Rückfallraten nach erfolgreicher Index-EKT bei pharmakoresistenter depressiver Störung liegen bei mehr als 50%, wenn in den ersten sechs Monaten keine adäquate Erhaltungstherapie mit Antidepressiva, Lithium, Stimmungsstabilisatoren und/ oder eine Erhaltungs-EKT erfolgt.

Summary

Despite new antidepressants and mood stabilizers at least 10% of patients with recurrent severe major depression fail to respond to sufficient pharmacotherapy or will not accept sufficient dosing. According to meta-analyses and systematic reviews electroconvulsive therapy (ECT) is still the most efficacious treatment of severe major depression. Yet, in Germany it is only offered to a minority of patients. An update about efficacy and cognitive and somatic side effects of right unilateral, bi-frontotemporal and bi-frontal ECT is given. In head-to-head trials bilateral ECT is superior to subconvulsive repetitive transcranial magnetic stimulation (rTMS). However, the relapse rates in pharmaco-resistant major depression after successful ECT are high (more than 50% in the first six months), if no adequate continuation therapy is initiated. Possible treatment options include antidepressants, lithium, mood stabilizers and/or continuation ECT within the first six months.

Schlüsselwörter

Elektrokrampftherapie - Pharmakoresistenz - Depression - Rückfallverhütung

Keywords

Electroconvulsive therapy - ECT - continuation therapy - pharmaco-resistant major depression

• Literatur

• 1 APA. Weiner RD. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training and Privileging: a task force report of the American Psychiatric Association, 2 ed. Washington, DC: American Psychiatric; 2001
• 2 Baghai T, Frey R, Kasper S, Möller HJ. Elektrokonvulsionstherapie. 1 ed. Wien: Springer; 2004: 1-478.
• 3 Baghai TC, Marcuse A, Moller HJ, Rupprecht R. Elektrokonvulsionstherapie an der Klinik für Psychiatrie und Psychotherapie der Universität München Entwicklung in den Jahren 1995–2002. Nervenarzt 2005; 76: 597-612.
• 4 Bourgon LN, Kellner CH. Relapse of depression after ECT: a review. J ECT 2000; 16: 19-31.
• 5 Bundesärztekammer Folkerts H, Remschmidt H, Saß H, Sauer H. Schäfer et al. Stellungnahme zur Elektrokrampftherapie (EKT) als psychiatrische Behandlungsmaßnahme. Deutsches Ärzteblatt 2003; 152: 141-144.
• 6 Eranti S, Mogg A, Pluck G, Landau S, Purvis R, Brown RG. et al. A randomized, controlled trial with 6-month follow-up of repetitive transcranial magnetic stimulation and electroconvulsive therapy for severe depression. Am J Psychiatry 2007; 164: 73-81.
• 7 Eschweiler GW. EKT und rTMS bei bipolaren Störungen. In: Assion HJ, Vollmoeller W. editors. Handbuch bipolare Störungen. Stuttgart: W. Kohlhammer; 2006: 166-174.
• 8 Eschweiler GW, Vonthein R, Bode R, Huell M, Conca A, Peters O. et al. Clinical efficacy and cognitive side effects of bifrontal versus right unilateral electroconvulsive therapy (ECT): A shortterm randomised controlled trial in pharmacoresistant major depression. J Affect Disord 2007; 101: 149-157.
• 9 Eschweiler GW, Wegerer C, Schlotter W, Spandl C, Stevens A, Bartels M. et al. Left prefrontal activation predicts therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) in major depression. Psychiatry Res 2000; 99: 161-172.
• 10 Eschweiler GW, Wild B, Bartels M. Elektromagnetische Therapien in der Psychiatrie. 1 ed. Darmstadt: Steinkopff; 2003: 1-262.
• 11 Fink M. Convulsive therapy: a review of the first 55 years. J Affect Disord 2001; 63: 1-15.
• 12 Folkerts H, Bender S, Erkwoh R, Klieser E, Klimke A, Schurig W. Entwurf von DGPPN-Leitlinien zur Indikation und Durchführung der Elektrokrampftherapie (EKT). Nervenarzt 1996; 67: 509-514.
• 13 Gaebel W, Falkai P, Weinmann GG, Wobrock T. S3 Leitlinie zur Schizophrenie. 2006. Berlin: DGPPN;
• 14 Gangadhar BN, Kapur RL, Kalyanasundaram S. Comparison of electro-convulsive therapy with imipramine in endogenous depression: a double blind study. Br J Psychiatry 1982; 141: 367-371.
• 15 Geddes J. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799-808.
• 16 Grunhaus L, Schreiber S, Dolberg OT, Polak D, Dannon PN. A randomized controlled comparison of electroconvulsive therapy and repetitive transcranial magnetic stimulation in severe and resistant nonpsychotic major depression. Biol Psychiatry 2003; 53: 324-331.
• 17 Herwig U, Lampe Y, Juengling FD, Wunderlich A, Walter H, Spitzer M. et al. Add-on rTMS for treatment of depression: a pilot study using stereotaxic coil-navigation according to PET data. J Psychiatr Res 2003; 37: 267-275.
• 18 Hihn H, Baune BT, Michael N, Markowitsch H, Arolt V, Pfleiderer B. Memory performance in severely depressed patients treated by electroconvulsive therapy. J ECT 2006; 22: 189-195.
• 19 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: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry 2006; 63: 1337-1344.
• 20 Kho KH, van-Vreeswijk MF, Simpson S, Zwinderman AH. A meta-analysis of electroconvulsive therapy efficacy in depression. J ECT 2003; 19: 139-147.
• 21 Kho KH, VanVreeswijk MF, Murre JM. A retrospective controlled study into memory complaints reported by depressed patients after treatment with electroconvulsive therapy and pharmacotherapy or pharmacotherapy only. J ECT 2006; 22: 199-205.
• 22 Lauritzen L, Odgaard K, Clemmesen L, Lunde M, Ohrstrom J, Black C. et al. Relapse prevention by means of paroxetine in ECT-treated patients with major depression: a comparison with imipramine and placebo in medium-term continuation therapy. Acta Psychiatr Scand 1996; 94: 241-251.
• 23 Lawson JS, Inglis J, Delva NJ, Rodenburg M, Waldron JJ, Letemendia FJ. Electrode placement in ECT: cognitive effects. Psychol Med 1990; 20: 335-344.
• 24 Letemendia FJ, Delva NJ, Rodenburg M, Lawson JS, Inglis J, Waldron JJ. et al. Therapeutic advantage of bifrontal electrode placement in ECT. Psychol Med 1993; 23: 349-360.
• 25 Lisanby SH, Maddox JH, Prudic J, Devanand DP, Sackeim HA. The effects of electroconvulsive therapy on memory of autobiographical and public events. Arch Gen Psychiatry 2000; 57: 581-590.
• 26 McCall WV, Reboussin DM, Weiner RD, Sackeim HA. Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Arch Gen Psychiatry 2000; 57: 438-444.
• 27 NICE Guidance on the use of electroconvulsive therapy. 2005 www.nice.org.uk .
• 28 Pascual-Leone A, Rubio B, Pallardo F, Catala MD. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. Lancet 1996; 348: 233-237.
• 29 Sackeim H, Decina P, Prohovnik I, Malitz S. Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments. Arch Gen Psychiatry 1987; 44: 355-360.
• 30 Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM. et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 2001; 285: 1299-1307.
• 31 Sackeim HA, Prudic J, Devanand DP, Kiersky JE, Fitzsimons L, Moody BJ. et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 1993; 328: 839-846.
• 32 Sackeim HA, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S. et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry 2000; 57: 425-434.
• 33 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.
• 34 Schott K. Die Geschichte der Elektrokrampftherapie. In: Eschweiler GW, Wild B, Bartels M. (eds). Elektromagnetische Therapien in der Psychiatrie. Darmstadt: Steinkopff; 2003: 3-5.
• 35 Squire LR, Slater PC, Miller PL. Retrograde amnesia and bilateral electroconvulsive therapy. Long-term follow-up. Arch Gen Psychiatry 1981; 38: 89-95.
• 36 Folkerts H. Persönliche Mitteilungen.