改良电抽搐与抗抑郁剂对抑郁症治疗的比较

Comparative Study between MECT and antidepressant in the treatment of depression

目的:分析比较改良电抽搐治疗(MECT)和抗抑郁剂治疗对抑郁症患者的疗效、血清皮质醇浓度和认知功能的影响。方法:将60例抑郁症患者随机分为MECT治疗组和常规抗抑郁剂治疗组。MECT组30例,每周1、3、5治疗,连续4周,以后每周一次维持治疗,共治疗12周。药物组30例,应用抗抑郁剂盐酸文拉法辛治疗,剂量在150mg～225mg/d之间,共治疗12周。所有入组病例,在入组时、治疗1周、治疗4周、治疗12周分别测汉密尔顿抑郁量表(HAMD)和血清皮质醇浓度。两组在入组时和治疗12周进行威斯康星卡片(WCST)评定。结果:HAMD分比较,在治疗1周、4周两组间有统计学差异(P<0.05),在第12周末两组间无统计学差异(P>0.05)。血清皮质醇浓度比较,第1、4周末两组间差异有统计学(P<0.05),在治疗12周两组间差异无统计学意义(P>0.05)。WCST评定在入组时两组间差异无统计学(P>0.05),在第12周末两组内均有统计学差异(P<0.05),而两组间在治疗12周差异无统计学意义(P>0.05)。血清皮质醇浓度与汉密尔顿抑郁量表总分,威斯康星卡片分类测验分类测验结果显示的认知功能情况存在相关性。结论:MECT是一种有效的治疗手段,相比较抗抑郁剂而言起效更快,对认知功能无不良反应,随病情好转对认知功能有改善。血清皮质醇浓度升高程度可能与抑郁症认知功能损害程度相关。

Objective： To analyze and compare the efficacy,serum cortisol concentration and cognitive functions of modified electric convulsive therapy（MECT） and anti-depressants treatment in depressive patients. Method：Sixty depressive patients were divided randomly into MECT group and antidepressants group. Thirty patients received MECT at Monday,Wednesday and Friday in each week,then did once a week after 4 weeks. The total time of receiving MECT was 12 weeks. And 30 patients received venlafaxine（Efexor） therapy（ 150 mg 225 mg, 12 weeks）. All the patients were evaluated HAMD and Wisconsin cards and detected serum cortisol concentration at the end of the 1 st,4th, 12th week. Results： According to the scores of HAMD and serum cortisol concentrations,there were significant differences between two groups at the end of I st,4th week（ P 〈 0.05 ） ,and no difference at the end of 12th week （P 〉 0.05 ）. According to the data of Wisconsin card, there was no significant difference before treatment and at the end of 12th week between two groups（ P 〉 0.05 ）. Serum cortisol concentration was positively cnrrelated with total score of HAMD, cognitive function of WCST. Conclusion： MECT is an effective and safe way in the treatment of depression,especially it can improve the cognitive function with little side effects. The increase of serum cortisol concentration may be associated with the degree of cognitive impairment.