阈下MECT联合抗抑郁药改善抑郁症患者自杀意念的随机对照试验

Sub-threshold modified electroconvulsive therapy combined with antidepressants to improve suicidal idea of depressive patients:a randomized controlled trial

目的:评估阈下MECT联合抗抑郁药改善抑郁症患者自杀意念的疗效。方法:采用随机对照试验,选取符合美国精神障碍诊断与统计手册(DSM-IV)抑郁障碍诊断标准的住院抑郁症患者108例,随机分为20%电量组、40%电量组及80%电量组。3组给予不同电量MECT治疗8次,分别采用汉密顿抑郁量表-17条目去除自杀条目(HAMD-16)、自杀意念自评量表(SIOSS)评估患者的抑郁症状和自杀意念。结果:3组HAMD-16评分(F=6.55)及SIOSS评分(F=4.29)时间×分组交互作用差异有统计学意义(P<0.05),不同分组评分随时间的变化趋势不同。在MECT末次治疗后,HAMD-16评分差值20%电量组小于40%和80%电量组[(-2.3±1.5)vs.(-5.4±3.5),(-4.1±2.3),均P<0.001],SIOSS评分差值20%电量组也小于40%和80%电量组[(-2.8±2.2)vs.(-6.1±3.3),(-4.9±2.2),均P<0.01],而40%电量组与80%电量组的HAMD-16和SIOSS评分差值的差异均无统计学意义(P>0.05)。结论:本试验提示40%电量MECT改善抑郁症患者自杀意念的疗效较好,20%电量MECT疗效较差不建议选择。

Objective:To evaluate the efficacy of sub-threshold MECT combined with antidepressants in improving suicidal ideation in depressive patients.Methods:A randomized controlled trial was conducted to select 108 inpatients with depression who met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders Fourth Edition(DSM-IV).They were randomly divided into 20%power group,40%power group and 80%power group.The three groups were treated with different power MECT for 8 times.Depressive symptoms and suicidal idea were assessed using the Hamilton Depression Scale-17 of eliminating suicide(HAMD-16)and Self-Rating Idea of Suicide Scale(SIOSS).Results:There were significant differences in HAMD-16 score(F=6.55)and SIOSS score(F=4.29)time*grouping interaction among the three groups(P<0.05).The change trend of HAMD-16 score and SIOSS score with time was different in different groups.After the last treatment of MECT,HAMD-16 score difference of 20%group is less than 40%and 80%group[(-2.3+1.5)vs.(-5.4±3.5)vs.(-4.1+2.3),Ps<0·01],and SIOSS score difference of 20%group is less than 40%and 80%group[(-2.8±2.2)vs.(-6.1±3.3)vs.(-4.9±2.2),P.s<0.01].But there was no significant difference between 40%group and 80%group in HAMD-16 and SIOS scores difference(P>0.05).Conclusion:This study suggests that 40%power MECT be effective in improving suicidal ideation in depressive patients,and 20%power MECT may be not recommended for its poor efficacy.