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Elektrokonvulsionstherapie zur Behandlung unipolar depressiver Störungen

Electroconvulsive therapy for the treatment of major depression

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Zusammenfassung

Hintergrund

Depressive Störungen sind häufig und führen zu hohem individuellem Leiden sowie sozioökonomischen Kosten. Trotz verschiedener effektiver Therapieoptionen wird die Remission als Ziel der Behandlung oft nicht erreicht. Der Einsatz der Elektrokonvulsionstherapie (EKT) kann hier eine sinnvolle Option sein.

Ziel der Arbeit

Diese Arbeit stellt die aktuelle Evidenz zu Wirksamkeit, Sicherheit und Verträglichkeit der EKT bei depressiven Störungen dar.

Material und Methoden

Es wurde eine selektive Literaturrecherche unter besonderer Berücksichtigung von Metaanalysen, systematischen Reviews sowie Empfehlungen nationaler und internationaler Leitlinien durchgeführt.

Ergebnisse

EKT stellt ein wirksames und für die meisten Patienten sicheres und gut verträgliches Verfahren zur Therapie depressiver Störungen dar. Auch bei Pharmakotherapieresistenz finden sich noch relativ hohe Remissionsraten. Für bestimmte Populationen scheint eine besonders gute Wirksamkeit zu bestehen. Im Gegensatz zur gut belegten Wirksamkeit der Akuttherapie fehlen weitgehend belastbare Daten zur Erhaltungstherapie. Unerwünschte Wirkungen, insbesondere kognitive Störungen, sind in der Regel nur kurzfristig vorhanden. Modifikationen in der Durchführung haben Auswirkungen auf die Wirksamkeit und Verträglichkeit.

Diskussion

Mit der EKT steht ein bei korrekter Anwendung hochwirksames Therapieverfahren zur Behandlung depressiver Störungen zur Verfügung. Angesichts der Häufigkeit depressiver Störungen und einer vielfach nicht erreichten Remission wäre eine weitere Ausweitung der Verfügbarkeit und Anwendung der EKT genauso wünschenswert wie eine intensivierte, ggf. multizentrische Forschung zu den Wirkmechanismen und Responseprädiktoren der EKT.

Summary

Background

Depressive disorders are common and lead to both individual suffering and high socioeconomic costs. Despite the fact that several effective therapies are available, remission is often not achieved. Electroconvulsive therapy (ECT) can be a therapeutic option in these cases.

Objectives

This review outlines the current evidence for the efficacy, safety and tolerability of ECT for depressive disorders.

Material and methods

A selective literature search was carried out with particular consideration of meta-analyses, systematic reviews, and recommendations of national and international therapy guidelines.

Results

For the majority of patients ECT is an effective, safe and well-tolerated therapy for the treatment of depressive disorders. There are relatively high remission rates even in patients with pharmacoresistant depression. There is evidence for a particularly high responsiveness in specific populations. In contrast to the proven effectiveness in the acute treatment of depressive disorders, there is a relative lack of data concerning maintenance therapy. Side effects including cognitive deficits are mostly transient. Modifications in the ECT technique have an impact on effectiveness and tolerability.

Conclusion

When administered correctly ECT is a highly effective therapy for the treatment of depressive disorders. In the light of the abundance of depressive disorders and lack of remission despite adequate pharmacological treatment, a broader availability and application of ECT would be desirable. The same is true for a more intensive research into the mechanisms of action and response predictors of ECT.

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Literatur

  1. Jacobi F, Höfler M, Strehle J et al (2014) Psychische Störungen in der Allgemeinbevölkerung. Nervenarzt 85:77–87

    Article  CAS  PubMed  Google Scholar 

  2. Sobocki P, Jönsson B, Angst J, Rehnberg C (2006) Cost of depression in Europe. J Ment Health Policy Econ 9:87–98

    PubMed  Google Scholar 

  3. DGPPN für die Leitliniengruppe Unipolare Depression (2009) S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Kurzfassung, 1. Aufl. DGPPN, ÄZQ, AWMF, Berlin

  4. Judd LL, Akiskal HS, Maser JD et al (1998) Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord 50:97–108

    Article  CAS  PubMed  Google Scholar 

  5. Keller MB, Lavori PW, Mueller TI et al (1992) Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry 49:809–816

    Article  CAS  PubMed  Google Scholar 

  6. Trivedi MH, Rush AJ, Crismon ML et al (2004) Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project. Arch Gen Psychiatry 61:669–680

    Article  PubMed  Google Scholar 

  7. Bauer M, Pfennig A, Linden M et al (2009) Efficacy of an algorithm-guided treatment compared with treatment as usual: a randomized, controlled study of inpatients with depression. J Clin Psychopharmacol 29:327–333

    Article  PubMed  Google Scholar 

  8. Payne NA, Prudic J (2009) Electroconvulsive therapy: Part II: a biopsychosocial perspective. J Psychiatr Pract 15:369–390

    Article  PubMed Central  PubMed  Google Scholar 

  9. Loh N, Nickl-Jockschat T, Sheldrick AJ, Grözinger M (2013) Accessibility, standards and challenges of electroconvulsive therapy in Western industrialized countries: a German example. World J Biol Psychiatry 14:432–440

    Article  PubMed  Google Scholar 

  10. UK ECT Review Group (2003) Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 361:799–808

    Article  Google Scholar 

  11. Kho KH, Vreeswijk MF van, Simpson S, Zwinderman AH (2003) A meta-analysis of electroconvulsive therapy efficacy in depression. J ECT 19:139–147

    Article  PubMed  Google Scholar 

  12. Pagnin D, Queiroz V de, Pini S, Cassano GB (2004) Efficacy of ECT in depression: a meta-analytic review. J ECT 20:13–20

    Article  PubMed  Google Scholar 

  13. Husain MM, Rush AJ, Fink M et al (2004) 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 65:485–491

    Article  PubMed  Google Scholar 

  14. Petrides G, Fink M, Husain MM et al (2001) ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. J ECT 17:244–253

    Article  CAS  PubMed  Google Scholar 

  15. O’Connor MK, Knapp R, Husain M et al (2001) The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report. Am J Geriatr Psychiatry 9:382–390

    Article  Google Scholar 

  16. Heijnen WT, Birkenhäger TK, Wierdsma AI, Broek WW van den (2010) Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: a meta-analysis. J Clin Psychopharmacol 30:616–619

    Article  PubMed  Google Scholar 

  17. Rush AJ, Trivedi MH, Wisniewski SR et al (2006) Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 163:1905–1917

    Article  PubMed  Google Scholar 

  18. Sackeim HA, Dillingham EM, Prudic J et al (2009) Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects. Arch Gen Psychiatry 66:729–737

    Article  CAS  PubMed  Google Scholar 

  19. Kellner CH (2012) Brain stimulation in psychiatry. ECT, DBS, TMS and other modalities. Cambridge University Press, Cambridge

  20. Sackeim HA, Haskett RF, Mulsant BH et al (2001) Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 285:1299–1307

    Article  CAS  PubMed  Google Scholar 

  21. Petrides G, Tobias KG, Kellner CH, Rudorfer MV (2011) Continuation and maintenance electroconvulsive therapy for mood disorders: review of the literature. Neuropsychobiology 64:129–140

    Article  PubMed Central  PubMed  Google Scholar 

  22. Kellner CH, Knapp RG, Petrides G et al (2006) 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 63:1337–1344

    Article  PubMed Central  PubMed  Google Scholar 

  23. Gagné GG Jr, Furman MJ, Carpenter LL, Price LH (2000) Efficacy of continuation ECT and antidepressant drugs compared to long-term antidepressants alone in depressed patients. Am J Psychiatry 157:1960–1965

    Article  PubMed  Google Scholar 

  24. Nordenskjöld A, Knorring L von, Ljung T et al (2013) Continuation electroconvulsive therapy with pharmacotherapy versus pharmacotherapy alone for prevention of relapse of depression: a randomized controlled trial. J ECT 29:86–92

    Article  PubMed  Google Scholar 

  25. National Institute for Health & Clinical Excellence (2014) The treatment and management of depression in adults. 2009. http://guidance.nice.org.uk/CG90. Zugegriffen: 29. Jan. 2014

  26. APA (2010) Practice guideline for the treatment of patients with major depressive disorder. American Psychiatric Association, Washington, DC

  27. Bauer M, Pfennig A, Severus E et al (2013) World Federation of Societies of Biological Psychiatry [WFSBP] guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 14:334–385

    Article  PubMed  Google Scholar 

  28. Payne NA, Prudic J (2009) Electroconvulsive therapy: Part I. A perspective on the evolution and current practice of ECT. J Psychiatr Pract 15:346–368

    Article  PubMed Central  PubMed  Google Scholar 

  29. Benbow SM, Crentsil J (2004) Subjective experience of electroconvulsive therapy. Psychiatr Bull 28:289–291

    Article  Google Scholar 

  30. Devanand DP, Fitzsimons L, Prudic J, Sackeim HA (1995) Subjective side effects during electroconvulsive therapy. Convuls Ther 11:232–240

    CAS  PubMed  Google Scholar 

  31. Brodaty H, Berle D, Hickie I, Mason C (2001) „Side effects“ of ECT are mainly depressive phenomena and are independent of age. J Affect Disord 66:237–245

    Article  CAS  PubMed  Google Scholar 

  32. Devanand DP, Dwork AJ, Hutchinson ER et al (1994) Does ECT alter brain structure? Am J Psychiatry 151:957–970

    Article  CAS  PubMed  Google Scholar 

  33. Agelink MW, Andrich J, Postert T et al (2001) Relation between electroconvulsive therapy, cognitive side effects, neuron specific enolase, and protein S-100. J Neurol Neurosurg Psychiatry 71:394–396

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Dwork AJ, Christensen JR, Larsen KB et al (2009) Unaltered neuronal and glial counts in animal models of magnetic seizure therapy and electroconvulsive therapy. Neuroscience 164:1557–1564

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Semkovska M, McLoughlin DM (2010) Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry 68:568–577

    Article  PubMed  Google Scholar 

  36. Verwijk E, Comijs HC, Kok RM et al (2012) Neurocognitive effects after brief pulse and ultrabrief pulse unilateral electroconvulsive therapy for major depression: a review. J Affect Disord 140:233–243

    Article  PubMed  Google Scholar 

  37. Grözinger M, Conca A, Nickl-Jockschat T, Di Pauli J (2013) Elektrokonvulsionstherapie kompakt. Springer-Verlag, Berlin

  38. Semkovska M, Keane D, Babalola O, McLoughlin DM (2011) Unilateral brief-pulse electroconvulsive therapy and cognition: effects of electrode placement, stimulus dosage and time. J Psychiatr Res 45:770–780

    Article  PubMed  Google Scholar 

  39. Spaans HP, Kho KH, Verwijk E et al (2013) Efficacy of ultrabrief pulse electroconvulsive therapy for depression: a systematic review. J Affect Disord 150:720–726

    Article  PubMed  Google Scholar 

  40. McCall WV, Reboussin DM, Weiner RD, Sackeim HA (2000) Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Arch Gen Psychiatry 57:438–444

    Article  CAS  PubMed  Google Scholar 

  41. Nobler MS, Sackeim HA, Solomou M et al (1993) EEG manifestations during ECT: effects of electrode placement and stimulus intensity. Biol Psychiatry 34:321–330

    Article  CAS  PubMed  Google Scholar 

  42. Krystal AD, Weiner RD (1999) EEG correlates of the response to ECT: a possible antidepressant role of brain-derived neurotrophic factor. J ECT 15:27–38

    CAS  PubMed  Google Scholar 

  43. Mayur P (2006) Ictal electroencephalographic characteristics during electroconvulsive therapy: a review of determination and clinical relevance. J ECT 22:213–217

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Zilles, C. Wolff-Menzler und J. Wiltfang geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Deutschland

    D. Zilles, C. Wolff-Menzler & J. Wiltfang

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  1. D. Zilles
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  2. C. Wolff-Menzler
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  3. J. Wiltfang
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Correspondence to D. Zilles.

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Zilles, D., Wolff-Menzler, C. & Wiltfang, J. Elektrokonvulsionstherapie zur Behandlung unipolar depressiver Störungen. Nervenarzt 86, 549–556 (2015). https://doi.org/10.1007/s00115-014-4101-z

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