重复经颅磁刺激治疗抑郁症负性认知及情绪的疗效观察

Effect of repetitive transcranial magnetic stimulation on negative cognition and emotion in depression

目的探讨药物治疗基础上联合重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对抑郁症患者负性认知及情绪的影响。方法将抑郁症患者60例随机分为研究组(n=30,在氟西汀治疗的基础上联合rTMS)及对照组(n=30,单用氟西汀治疗),在治疗前、治疗2周、4周、6周末,采用汉密尔顿抑郁量表24项版本(Hamilton rating scale for depression,HAMD-24)评估患者抑郁程度,采用自动思维量表(automatic thoughts questionnaire,ATQ)评估患者负性认知情况。结果重复测量方差分析显示,HAMD-24评分的组别×时间交互作用无统计学意义(F=0.455,P=0.586),组别主效应(F=11.754,P=0.001)与时间主效应(F=787.600,P<0.001)均有统计学意义,随时间推移,两组HAMD评分降低均有统计学意义(P<0.001)。治疗6周末研究组的HAMD减分率高于对照组(77.1%±6.8%vs.72.4%±9.7%,t=2.152,P=0.036)。ATQ评分的组别×时间交互作用有统计学意义(F=6.512,P=0.004),治疗后两组ATQ评分降低均有统计学意义(P<0.001),且研究组在治疗2周末、4周末、6周末的评分均低于对照组(P<0.05)。结论药物联合rTMS不仅有助于改善抑郁症患者的抑郁情绪,也有利于改善其负性认知。

Objective To explore the effect of combined repetitive transcranial magnetic stimulation （rTMS） onnegative cognition and emotion in depression. Methods Sixty patients with major depressive disorder were randomlyassigned into trial group （n=30, received fluoxetine and rTMS therapy） or control group （n=30, received fluoxetinealone）. The Hamilton Rating Scale for Depression -24 items （HAMD -24） was used to evaluate the severity ofdepression and the Automatic Thoughts Questionnaire （ATQ） was employed to assess the degree of negative cognitionfor all subjects before and after 2, 4 and 6 weeks of treatment. Results The repeated measures ANOVA revealedthat the interactive effect of group and time for HAMD-24 was not significant （F=0.455, P=0.586）, while there wassignificant main effect of group （F=11.754, P=0.001） and time （F=787.600, P〈0.001）. HAMD-24 scores in bothgroups significantly decreased over time（P〈0.001）. The reduction rate of HAMD-24 score was significant higher inthe trial group than in the control group after 6-week treatment （77.1%±6.8% vs. 72.4%±9.7%, t=2.152, P=0.036）.The interactive effect of group and time for ATQ was significant（F=6.512,P=0.004）. Simple effect analyses indicatedthat ATQ score significantly reduced over time in both groups （all P〈0.001）. At the baseline, the ATQ scores were nosignificant difference between the trial and control group. The ATQ scores were significantly lower in the trial groupthan in control group at the 2-weekend, 4-weekend and 6-weekend,（P〈0.05）. Conclusion Combination of rTMS improves not only the depressive emotion, but also the negative cognition in patients with major depressive disorder.