难治性抑郁症停药清洗合并MECT一周及后续治疗反应

The study of treatment response of one week washout with MECT and subsequent treatment on treatment refractory depression

目的探讨对难治性抑郁症患者,停药清洗1周并同期合并无抽搐电休克治疗(MECT)的效果,并评价1周后续用先前抗抑郁药的治疗反应。方法将符合《中国精神障碍分类与诊断手册(第3版)》(CCMD-3)抑郁症诊断标准的40例难治性抑郁症患者,予1周的清洗,清洗期停用除苯二氮艹卓类药物以外的所有精神科药物,同期合并MECT治疗,清洗期结束后继续使用原抗抑郁药物,共观察6周。在MECT治疗前及治疗后第1、2、4、6周末分别采用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)评定疗效,用副反应量表(TESS)评定不良反应。结果①6周末痊愈14例,显效17例,进步7例,无效2例。有效率77.5%。②治疗第1周末(清洗期合并MECT后)HAMD-17、HAMA评分较治疗前差异有统计学意义(P均<0.01)。治疗第4周末(即重新开始续用原抗抑郁药后第3周)和第6周末HAMD-17、HAMA评分与第1周末比较差异均有统计学意义(P<0.05或0.01)。结论停药清洗1周合并MECT对难治性抑郁症效果良好,经过清洗合并MECT后可提高原抗抑郁药物的疗效。

Objective To evaluate the treatment response of a week washout with MECT and subsequent treatment on treatment refractory depression. Methods 40 patients with treatment refractory depression were discontinued all psychotropic drugs except henzodiazepines and received MECT for a week and subsequent antidepressant drugs combined with MECT treatment for five weeks. The HAMD - 17 ,HAMAand TESS were measured respectively before MECT and after MECT for 1,2,4,6 weeks. Results①After 6 weeks MECT, The symptoms of 14 patients were in remission, 17 patients had treatment response , and the efficiency rate is 77.5%. ②HAMD - 17 and HAMA scores were decreased significantly after a week treatment. There were significant differences in HAMD - 17 and HAMA scores afterl, 4, 6 weeks treatment compared with the baseline, at the same time, the scores at the end of 4 and 6 weeks treatment were significantly decreased than that at the end of 1 week treatment. Conclusion The effect of treatment withdrawal with MECT is good, and subsequent antidepressant drugs combined with MECT treatment can improve the therapeutic efficacy of the antidepressant drugs.