Efficacy And Side Effects Of Mixed-Strategy Electroconvulsive Therapy:A Proof-of-Concept Randomized Clinical Trial On Late-Life Depression

Background: Late life depression in the elderly is a common mental disease characterized by loss of interest,depressed mood,and decreased energy.Some patients have cognitive dysfunction.With the growth of age and the recrudescence of late life depression,drug treatment takes effect more slowly and adverse drug reactions are more likely to occur,while the antidepressant effect of electroconvulsive therapy is more rapid and effective.However,late life depression are more likely to have adverse events such as cognitive impairment,headache,delirium,etc.A part of late life depression terminated electroconvulsive therapy due to adverse reactions in the process of electroconvulsive therapy,which limited the clinical application of electroconvulsive therapy.In order to reduce the side effect in the process of electroconvulsive therapy,we designed a mixed strategy electroconvulsive therapy.In the mixed strategy electroconvulsive therapy,the patient will receive conventional electroconvulsive therapy in the first three electric convulsions,and receive low charge electroconvulsive therapy in the subsequent treatment.However,at present,it remains unknown whether the reduction of electricity will affect the efficacy and reduce the adverse reactions of patients with late-onset depression.Objective: To compare the efficacy and adverse reactions of mixed strategy electroconvulsive therapy and conventional electroconvulsive therapy.To explore whether there is any difference between mixed strategy electroconvulsive therapy and conventional electroconvulsive therapy in antidepressant efficacy,cognitive impairment and incidence of adverse events.Methods: The randomized controlled trial was conducted from 2019 to 2021.A total of ages 60 and older patients with late life depression were randomly divided into conventional electric convulsion group(n=30)and mixed strategy electroconvulsive therapy group(n=30).Chi-square test was used to compare whether there were differences in the remission rate and the incidence of adverse events between the two groups,and the generalized estimation equation was used to compare whether there were differences in the trend of the improvement of depression level and the severity of cognitive impairment in the two groups with the treatment time.Results: The remission rate of antidepressant treatment in both groups was 63.3%,and there was no difference between the two groups(χ2=0.277,p=1).There was no difference in the level of depression improvement between the conventional electroconvulsive therapy group and the mixed strategy electroconvulsive therapy group with the increased electroconvulsive therapy sessions(Wald χ2=7.275,p=0.064).After reducing the intensity of electrical stimulation,the cognitive impairment of the mixed strategy electroconvulsive therapy group was less than that of the conventional electric quantity group(Wald χ2=8.463,p=0.015).After reducing the power,the number of adverse events in the mixed strategy electroconvulsive therapy was less(χ2=13.467,p=0.004).Conclusion: The mixed strategy electroconvulsive therapy group retains the antidepressant effect of conventional electroconvulsive therapy,with fewer adverse reactions than conventional electroconvulsive therapy.