重复经颅磁刺激联合抗抑郁药对抑郁症首次发病患者的早期疗效及认知功能的影响

Repetitive transcranial magnetic stimulation combined with antidepressant medication in treatment of first-episode patients with major depression

目的:探讨重复经颅磁刺激(rTMS)联合抗抑郁药物对抑郁症首次发病患者的早期疗效及认知功能的影响。方法:选择符合《美国精神障碍诊断统计手册第四版(DSM-IV)》抑郁发作诊断标准,年龄为18~45岁的60例首发抑郁症患者。随机分为研究组和对照组,两组均服用氢溴酸西酞普兰片20 mg/d,研究组加用2周rTMS真性刺激,以10 Hz、90%运动阈值刺激患者左前额叶背外侧;对照组加用2周rTMS伪刺激治疗。采用汉密顿抑郁量表(HAMD)测评患者治疗前后的疗效;采用威斯康星卡片分类测验(WCST)和持续操作测验(CPT)评估治疗前后的认知功能。结果:①治疗2周后,研究组有效率高于对照组(57%vs29%,P<0.05)。②治疗后两组患者HAMD总分明显下降,2周时研究组的HAMD总分低于对照组(15.36±1.73vs17.43±2.44,P<0.01)。③在WCST测验中,治疗后研究组分类数增加(P<0.05),并且好于对照组(P<0.05),其他指标无统计学差异。在CPT测验中各项指标均无统计学差异。④经rTMS治疗后患者未见严重的不良事件发生。结论:10 Hz rTMS辅助氢溴酸西酞普兰片治疗抑郁症,能增强患...

Objective:To assess the early therapeutic and cognitive effect of repetitive transcranial magnetic stimulation(rTMS) combined with antidepressant medication in treatment of first-episode patients with major depression.Methods:Sixty first-episode depressed inpatients aged 18-45 y,who met the DSM-IV clinical criteria for major depressive episode were randomly assigned to citalopram treatment(20 mg/d) in combination with a two-week period of either rTMS(study group)or sham procedure(control group) on left dorsal-lateral prefrontal cortex(10 Hz,90% motor threshold).The Hamilton Depression Rating Scale(HAMD) was used to assess the severity of depression.The Wisconsin Card Sorting Test(WCST) and Continuous Performance Test(CPT) were used to assess cognitive function of depression.Results:The response rate was significantly greater in the study group compared to the control group after treatment(57% vs 29%,P<0.05).The HAMD scores significantly declined after treatment in two groups,and the study group showed lower scores compared to the control group after 2 weeks(P<0.01).Neuropsychological assessments showed that there was no significant difference between the two groups except for the significant improvement in the categories on WCST in study group compared to the baseline(P<0.05)and the control group(P<0.05)after 2 weeks treatment.No serious event occured in the patients during the rTMS study.Conclusion:10 Hz rTMS enhances early effects of citalopram and improves cognitive function in first-episode major depressive patients.