(SALT LAKE CITY)—Although electroconvulsive therapy (ECT) has long been considered the most effective treatment of medication-resistant depression, millions of people who could benefit don’t take advantage of it because of the treatment’s side effects and public misperception of the procedure.
If the results of a campus-wide collaboration of University of Utah researchers are borne out by larger studies and trials, patients with refractory depression might one day have an alternative that is as effective as ECT but without the side effects – the surgical anesthetic drug isoflurane.
“大发娱乐需要将大发娱乐的研究扩展到一个更大的, 多中心试验, 但如果大发娱乐的初步研究结果成立, 这将改变治疗抑郁症的面貌,” 霍华德R. 周,米.D.，香港大学副教授 精神病学 and first author on a study published July 26, 2013, in 《大发娱乐》 在线.
也被称为休克疗法, ECT is effective in 55 percent to 90 percent of depression cases, with significant reductions in symptoms typically occurring within two to four weeks. When medications work, they can take six to eight weeks to become effective. But ECT is associated with side effects including amnesia, 集中和注意力问题, 以及其他认知问题. Many people also mistakenly believe ECT is painful and causes brain damage, which has given the treatment a social stigma that makes millions of patients reluctant to have it. Isoflurane potentially offers an alternative to ECT that could help many of those people, 据威克斯说 and his colleagues from eight University of Utah departments and programs.
In a pilot study with 20 patients who received ECT treatments compared to eight patients who received the isoflurane treatments, the researchers found that both therapies provided significant reduction in symptoms of depression. 治疗后立即, ECT patients showed declines in areas of memory, 语言流畅, 和处理速度. Most of these ECT-related deficits resolved by four weeks. 然而, 自传记忆, 或者回忆个人生活事件, remained below pretreatment levels for ECT patients four weeks after the treatment. 与此形成鲜明对比的是, the patients treated with isoflurane showed no real impairment but instead had greater improvements in cognitive testing than ECT patients both immediately and four weeks after the treatments.
In the mid-1980's, researchers in Europe studied isoflurane as a potential depression therapy. Later studies by other scientists failed to confirm the results of the original work and isoflurane research fell out of favor. But these later studies didn't adhere to the first study's protocol regarding type of anesthetic, 剂量大小和处理次数, 据威克斯说, and he believes that's why isoflurane's antidepressant effects weren't confirmed in subsequent trials. 对于他们的研究, Weeks and his University of Utah colleagues followed the original study's protocol.
"Our data reconfirm that isoflurane had an antidepressant effect approaching ECT with less adverse neurocognitive effects, and reinforce the need for a larger clinical trial,研究人员写道.
研究ers don't know what produces the relief of depression symptoms from ECT or isoflurane. Weeks believes further research might identify a molecular pathway that both therapies target and is responsible for the improvement in depression. One common effect of both ECT and isoflurane treatments is a brief state of low electrical activity in which the brain becomes unusually quiet. ECT induces a seizure to reach that state, but isoflurane does not. 吸入麻醉后, 病人会“昏睡”大约45分钟, with 15 minutes of that time being a deep state of unconsciousness, 据威克斯说. This period of electrical rest for the brain may be a potential explanation for why ECT and isoflurane improve depression.
If isoflurane proves to be a viable alternative to ECT, a device invented by three University of Utah anesthesiology faculty members can make the anesthetic an even more attractive therapy. 的Aneclear™ device (Anecare, Salt Lake City, UT) invented by Dwayne R. Westenskow, Ph值.D.德里克·J. 坂田,M.D.约瑟夫·A. 奥尔,Ph值.D., from the University of Utah Department of Anesthesiology, uses hyperventilation and allows patients to rebreathe their own carbon dioxide (C02). Hyperventilation removes anesthesia from the lungs and C02 encourages blood flow to the brain, 哪种方法能更快地去除麻醉剂. 的Aneclear™ 也可以减少甚至消除呕吐, 恶心想吐, and extreme fatigue that some patients experience from anesthesia.
“用Aneclear™, we can wake people up from the anesthesia much quicker," Weeks says. "This makes the treatment a potentially viable clinical treatment by reducing the time required in an operating room."
Weeks and his co-researchers now are looking for grants to fund a larger study that will include several U.S. 中心.
The other authors on this study, all from the University of Utah, are: Scott C. Tadler, M.D.凯利·W. 史密斯,米.D.凯瑟琳·C. 光,Ph值.D.迈克尔·K. Cahalan, M.D.德里克·J. 坂田,M.D.伊莱·雅各布博士.D.约书亚·D. Landvatter, M.A.艾伦·R. 光,Ph值.D, all of the Department of Anesthesiology; Andrea T. 白色,Ph值.D., Department of Exercise and Sport Science; Gordon J. 彻璐说,Ph值.D., Department of Neurology; Yana Suchy, Ph.D., Departments of Psychology and Neurology; Elaine Clark, Ph.D.和米卡拉·萨科曼博士.D., both of the Department of Educational Psychology; and Lowry A. 布什内尔,M.D.精神科主任.