以头痛为第一主诉的抑郁症

THE DEPRESSIVE PATIENTS WITH HEADACHE AS THE FIRST COMPLAIN

本文应用Ｚｕｎｇ抑郁自评量表对以头痛为第一主诉，病程超过３个月的２６０例门诊患者进行了常规筛选，其中２０５例患者的粗分大于４０，标准分均大于６０，提示为抑郁状态，检出阳性率为７８．８％。凡Ｚｕｎｇ抑郁自评量表为抑郁状态者，Ｈａｍｉｌｔｏｎ抑郁量表评分均大于１６分，其中大于２４分者１０８例，占总受检者的４１．５％。抗抑郁治疗六周后，大部分患者头痛症状缓解，睡眠改善，生活和工作能力恢复，抑郁自评量表得分明显下降。新型的抗抑郁药物５ＨＴ再摄取抑制剂氟西汀和舍曲林为起效快、副作用较小、耐受较好的药物。

cases complaining of headache to our department were examinied by the Zung's and Hamilton's Scales of depression. 78.8% of patients (205 cases) got the high levels of Zung's scale and 41.5% of patients (108 cases) had the scales of Hamiltion above 24.0. Some of them were treated with the anti depressive: Doxepin, Fluoxetine, Sertraline and Deanxit, and re examinied by both scales. The results showed that after 6 weeks of treatment the effects of 5 HT reuptake inhibitor Fluoxetine and sertralin on the depressive patients were better than that of Doxepin. The symptoms of headache in most of the patients treated with 5 HT reuptake inhibitor disappeared. The after treatment scales were singnificantly decreased compared with that before treatment (P<0.001). In conclusion: headache is often the first complain in many depressive patients who see neurologists. Therefore, it is important for neurologists to pay attention to the depression in the Out Patient Department of general hospital.