重复经颅磁刺激联合文拉法辛对老年抑郁症疗效及认知功能的影响

A comparative study of repetitive transcranial magnetic stimulation combined with venlafaxine to treat patients with senile depression

目的观察重复经颅磁刺激(rTMS)联合盐酸文拉法辛对老年抑郁症患者疗效及认知功能的影响。方法将61例老年抑郁症患者,随机分为rTMS组(rTMS联合文拉法辛治疗)和假刺激组(假刺激联合文拉法辛治疗),rTMS组31例,假刺激组30例。采用汉密尔顿抑郁量表(HAMD)、治疗中需处理的不良反应症状量表(TESS)评价临床疗效和不良反应,采用数字广度测验(DST)和威斯康星卡片分类测验(WCST)评估认知功能。结果治疗后第4周末两组显效率比较差异无统计学意义(P>0.05),治疗后第1、2、4周末rTMS组HAMD评分低于假刺激组(P<0.01),两组不良反应发生率比较差异无统计学意义(P>0.05),治疗后第4周末rTMS组DST正序评分和总评分均高于假刺激组(P<0.05),治疗后第4周末rTMS组WCST错误应答数和持续错误数均低于假刺激组(P<0.01),总应答数与正确应答数均高于假刺激组(P<0.01)。结论单独使用文拉法辛较rTMS联合文拉法辛治疗老年抑郁症疗效相当,不良反应相似,但是联合干预起效更快而且在改善老年抑郁症患者认知功能方面疗效更优。

Objective To explore the effect of repetitive transcranial magnetic stimulation（ rTMS） combined with venlafaxine on the efficacy and cognitive function in patients with senile depression. Methods 61 patients with senile depression were selected and randomly divided into rTMS group（ n = 31） treated with rTMS combined with venlafaxine and sham stimulus group（ n= 30） treated with sham stimulus combined with venlafaxine. They were assessed with Hamilton Depression Scale（ HAMD）,Treatment Emergent Symptoms Scale（ TESS）,Digit Span Test（ DST） and Wisconsin Card Sorting Test（ WCST） for efficacy,side effects and cognitive function. Results At the 4thweekend after treatment,there were no significant differences on efficacy and incidence rates of side effects between both groups（ P〈0. 05）. At the 1st,2nd and 4tthweekend after treatment,the total score of HAMD in rTMS group was lower than that in sham stimulus group（ P〈0. 01）. At the 4thweekend after treatment,the total score and positive sequence score of DST in rTMS group were significantly higher than those in sham stimulus group（ P〈0. 05）; the error responses and perseverative errors of WCST in rTMS group were less than those in sham stimulus group（ P〈0. 01） and the overall responses and correct responses were more than those in sham stimulus group（ P〈0. 01）. Conclusion There are no differences on efficacy and side effects between venlafaxine monopharmacy and venlafaxine combined with rTMS in patients with senile depression. However,the combination may take effect more rapidly and improve patients＇ cognitive function better.