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Nervenheilkunde 2008; 27(11): 1049-1054
DOI: 10.1055/s-0038-1627240
Originaler Artikel
Schattauer GmbH

Aktuelles zur Elektrokrampftherapie bei schweren depressiven Störungen

Update on electroconvulsive therapy in severe major depression
G. W. Eschweiler
1   Universitätsklinik für Psychiatrie und Psychotherapie Tübingen (Ärztlicher Direktor: Prof. Dr. med. G. Buchkremer)
,
A. M. Rapp
1   Universitätsklinik für Psychiatrie und Psychotherapie Tübingen (Ärztlicher Direktor: Prof. Dr. med. G. Buchkremer)
› Author Affiliations
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Publication History

Eingegangen am: 03 March 2008

angenommen am: 27 May 2008

Publication Date:
20 January 2018 (online)

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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
 

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