拉莫三嗪联合MECT治疗难治性抑郁症的临床对照研究

The Clinical Effect Observation for Treatment-resistant Depression with Lamotrigine Combined MECT Treatment

目的:观察拉莫三嗪联合MECT治疗难治性抑郁症的疗效;方法:选取符合入组条件的难治性抑郁症门诊或住院患者47名,采取病例组对照的方法,运用拉莫三嗪联合MECT治疗,观察期限6周。入组后拉莫三嗪1周后加至200mg/d;自第2周始,每周3次,隔日治疗,均接受总数8次的MECT治疗。对照组选取住院符合难治性的抑郁症患者39例,采取拉莫三嗪联合假性MECT治疗的方法,药物剂量同观察组。两组的效果评估采取精神科医生精神现况检查评估、患者及家属自我体验效果结合抑郁自评量表(SDS)和17项版本的汉密尔顿抑郁量表减分率共同评价。结果:研究组完成观察数44例。终止观察3例,脱落率6.38%,其中因出现皮疹终止观察2例,自行停止观察1例。对照组完成观察数37例,脱落2例,脱落率5.13%;两组的脱落率和副反应比较差异没有显著性(P>0.05)。研究结果显示,两组分别在精神科现况检查(PSE)、患者/家属体验、SDS和汉密尔顿抑郁量表(17项版本)的评定结果中,"痊愈"项目的两组间比较均显示出了差异性(χ~2=6.11,9.01,10.23,8.24;P<0.01)。患者/家属体验评估中两组间的"有效"指标比较,差异有显著性(χ~2=2.66,P<0.05);余项目的两组间比较没有显示出差异性(P>0.05)。结论:拉莫三嗪联合MECT治疗难治性抑郁症安全有效,可以作为候选方案之一;单用拉莫三嗪治疗难治性抑郁症疗效尚不确定。

Objective：To observation the treatment effect of lamotrigine combined modern electric-convulsive treatment（MECT）in treatment-resistant depression patients.Methods：A total of 47 patients were included in study group who met treatment-resistant refractory depression criteria and were treated by lamotrigine combined with MECT.Observation period was 6 weeks.Lamotrigine dosage was titrated to 200 mg per day after the first week.And we combined MECT from the second week,3 times a week,total 8 times.A total of 39 hospitalized patients were recruited in control group who met treatment-resistant refractory depression criteria too and were treated by lamotrigine combined with pseudo-MECT.The control group patients took the dosage of lamotrigine as same as the study group.Assessment of efficacy were taken three methods：Present state examination（PSE）,the effect of selfexperience from patients or their relatives,and using SDS and HAMD-17 item scales for survey and check respectively.Results：Of 47 patients in study group,3 cases discontinued,expulsion rate was 6.38%.Of 39 patients in control group,2 cases discontinued,expulsion rate 5.13%.There was no difference between this two groups（P〉0.05）.There were significant difference in PSE,the effect of self-experience from patients or their relatives,and using SDS and HAMD-17 item scales for survey and check respectively（χ~2=6.11,9.01,10.23,8.24;P〈0.01）between items：Comparison of the ＂recovery＂ items between two groups,and comparison of the ＂recovery plus effective＂ and ＂ineffective＂ in study group.There were difference between items（χ~2=2.66,P〈0.05）： ＂Effective＂ item in two groups for the effect of self-experience from patients or their relatives.There were no difference for compare between item（P〉0.05）：Comparison of the ＂recovery plus effective＂ and ＂ineffective＂ in control group,and ＂effective＂ item in two groups.Conclusion：This treatment program of lamotriging combined with MECT is safety and effective in treatment-resistant depression patients as one of the candidate schemes.But the effect of single drug regimen with lamotrigine for these patients is unknown.