重复经颅磁刺激联合抗抑郁药治疗首次发病老年抑郁症的初步研究

A preliminary study of repetitive transcranial magnetic stimulation combined with antidepressants in the treatment of first-episode late-life depression

目的探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合选择性5-羟色胺再摄取抑制剂(selective serotomin reuptake inhibitors,SSRIs)治疗首次发病老年抑郁症的临床疗效和安全性。方法筛查2019年6月至2020年1月就诊于首都医科大学附属北京安定医院的首次发病老年抑郁症患者,采用随机数字表法随机分为试验组(真rTMS+SSRIs,n=26)和对照组(伪rTMS+SSRIs,n=25),治疗4周,治疗后随访4周。rTMS治疗刺激强度120%运动阈值,刺激频率10 Hz,每周5次。在治疗第1、2、3、4周末及治疗后随访第4周末,采用17项汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD17)和患者健康问卷抑郁自评量表(Patient Health Questionnaire-9,PHQ-9)评定患者的临床症状,比较2组显效率和治愈率的差异。采用χ^(2)检验和重复测量方差分析进行统计比较。结果(1)治疗第4周末,试验组和对照组的显效率分别为69.23%(18/26)和36.00%(9/25),差异有统计学意义(χ^(2)=5.649,P=0.017);两组治愈率比较差异无统计学意义(P>0.05);(2)随访第4周末,试验组与对照组显效率和治愈率的比较差异无统计学意义(P>0.05);(3)在整个观察期间,时点与组别在HAMD17总分及PHQ-9总分存在交互作用(F=66.313,P=0.008;F=8.571,P<0.01)。结论120%运动阈值的rTMS联合SSRIs对老年抑郁症患者的治疗存在潜在优势,起效较单纯药物治疗快,但仍需大样本量的临床研究进行验证。

Objective To explore the clinical efficacy and safety of repetitive transcranial magnetic stimulation(rTMS)combined with selective serotonin reuptake inhibitors(SSRIs)in the treatment of first-episode late-life depression.Methods From June 2019 to January 2020,first-episode elderly patients with depression in Beijing Anding Hospital affiliated to Capital Medical University were screened and randomly divided into test group(true rTMS+SSRIs,n=26)and control group(rTMS sham+SSRIs,n=25)according to the random number table method.All the patients were treated for 4 weeks and followed up for 4 weeks after treatment.The test group received 20 sessions(5 sessions per week)of 10 Hz rTMS(120%of motor threshold).Hamilton Depression Scale(HAMD17)and The Patient Health Questionnaire-9(PHQ-9)were used to assess the clinical symptoms at the end of the 1st,2nd,3rd and 4th week of treatment and at the end of the 4th week of the follow-up after treatment,and the response rate and the rate of recovery were compared between the two groups,analyzed by theχ^(2) test and repeated measurement analysis of variance.Results(1)At the end of the 4th week of treatment 69.23%(18/26)subjects in the test group and 36.00%(9/25)in the control group significantly improved their depressive condition,which was defined as a more than 50%HAMD17 reduction(χ^(2)=5.649,P=0.017).However,there was no significant difference between the two groups when compared the rate of recovery,which was defined as a HAMD17≤7(P>0.05).(2)At the end of the 4th week of the follow-up,there was no significant difference in the response rate nor the rate of recovery between the two groups(P>0.05).(3)During the entire observation period,there was an interaction between the time point and the group in HAMD17 total score and PHQ-9 total score(F=66.313,P=0.008;F=8.571,P<0.01).Conclusion There might be potential advantages in the combination treatments by rTMS at 120%MT and SSRIs antidepressants for the elderly depressive patients,and the onset of efficacy is faster than that of pharmacotherapy alone,while the large sample clinical studies are still needed to confirm the benefits.