艾司西酞普兰合并支持性心理治疗对首发老年抑郁症治疗效果的对照研究

A control study of the efficacy of escitalopram combined with supportive psychotherapy in the treatment of first-episode geriatric depression

目的探讨支持性心理治疗对于老年抑郁症患者辅助治疗的效果。方法 94例老年抑郁症患者进行生活事件量表评定后,随机分为研究组(48例,接受艾司西酞普兰合并支持性心理治疗)和对照组(46例,接受艾司西酞普兰治疗),疗程8周。在治疗前及治疗2、4、6、8周末评定汉密尔顿抑郁量表(HAMD-17)及临床大体印象量表(CGI)以评估疗效,使用不良事件记录表记录治疗过程中出现的各种不良事件。结果 68例(72%)老年抑郁症患者在起病前1年内存在不良生活事件。两组治疗后4、6、8周末HAMD评分比治疗前显著降低(P<0.05),研究组上述时间点HAMD减分率显著高于对照组(P<0.05)。治疗结束时,总体有效率在两组间无显著性差异(P>0.05),但研究组痊愈率显著高于对照组(P<0.05)。两组不良反应发生率无显著性差异(P>0.05)。结论首发老年抑郁症患者存在较多的不良生活事件,合并使用支持性心理治疗可以提高老年抑郁症的临床治疗效果。

Objective To explore the efficacy of supportive psychotherapy as assistant therapy for the treatment of first-episode geriatric depression. Methods 94 patients aged 60 years old and above with first-episode depression were assessed with Life Events Scale （LES） and then randomized into study group （48 cases treated with escitalopram combined with supportive psychotherapy） and control group （46 cases treated with escitalopram monotherapy）. The course of treatment was 8 weeks. Hamilton Depression Scale-17 items （HAMD-17） was used to evaluate the efficacy at the baseline and the 2nd, 4th, 6th and 8th weekend. Adverse event log was used to record the side effects during the treatment. Results 68 （72%） patients with geriatric depression experienced negative life events within 1 year before the episode. Scores of HAMD at the 4th, 6th and 8th weekend in both groups decreased significantly compared with the baseline （ P 〈 0.05 ）. The reducing rate of HAMD in study group at each interview-point mentioned above was significantly higher than that in control group （ P 〈 0.05 ）. At the end of the treatment, there was no significant difference in overall effective power between the two groups （ P 〉 0.05 ）, but the recovery rate in study group was significantly higher than that in control group （ P 〈 0.05 ）. There was no significant difference in frequency of side effects between the two groups （ P 〉 0.05 ）. Conclusion Late-life patients with first-episode depression usually suffer from more negative lifeevents. Combination of supportive psychotherapy may boost the clinical treatment effectiveness in the treatment of geriatric depression.