经颅交流电刺激联合抗抑郁药对抑郁发作的疗效及安全性

Efficacy and safety of transcranial alternating-current stimulation combined with antidepressants in the treatment of depressive episode

目的探讨经颅交流电刺激(transcranial alternating-current stimulation,tACS)联合抗抑郁药对抑郁发作的治疗效果及安全性。方法选择抑郁发作患者62例,分为治疗组和对照组,均服用抗抑郁药物,治疗组加用tACS真刺激治疗,对照组加用tACS伪刺激治疗。治疗次数两组均为20次。治疗部位为前额部、双侧乳突部,频率为77.5 Hz,强度为15 mA。采用汉密尔顿抑郁量表-17项(Hamilton Depression Scale-17 Item,HAMD-17),汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评估患者治疗前后的临床症状,并评估安全性。评估时间点为基线,治疗结束时(4周末),随访时(8周末)。结果采用重复测量方差分析对治疗组和对照组在基线、治疗4周末、随访8周末时HAMD-17和HAMA的评分进行比较,显示两组HAMD-17总分均随治疗及随访时间的延长逐渐降低(P时间<0.05),治疗组降低幅度大于对照组(P组间<0.05),且随观察时间的延长治疗的效应增大(P交互<0.05)。两组HAMA总分均随治疗及随访时间的延长逐渐降低(P时间<0.05),但两组间差异无统计学意义(P组间>0.05)。治疗组和对照组第4周末HAMD-17的减分率分别为74.29%±8.40%vs 32.54%±13.30%;第8周末HAMD-17的减分率分别为81.00%±10.68%vs 40.27%±12.92%,差异均有统计学意义(P<0.001)。两组均无严重不良事件发生。结论经颅交流电刺激联合抗抑郁药物治疗抑郁发作能够增强治疗效果,且安全性高,可作为抑郁发作联合治疗的新选择。

Objective To investigate the efficacy and safety of transcranial alternating current stimulation(tACS)combined with antidepressants in the treatment of depression.Methods Sixty-two patients with depressive episode were randomly divided into treatment group and control group.Both groups took antidepressants.The patients in the treatment group received real tACS while the patients in the control group were treated with sham tACS.The treatment session was 20 times in both groups.The treatment site was prefrontal and bilateral mastoid,with a frequency of 77.5 Hz and intensity of 15 mA.Hamilton Depression Scale-17 Item(HAMD-17)and Hamilton Anxiety Scale(HAMA)were used to evaluate the clinical symptoms at baseline,the end of treatment(4 weeks),and follow-up(8 weeks).Results The scores of HAMD-17 and HAMA in the treatment and control groups at baseline,4 weeks of treatment,and 8 weeks of follow-up were compared with repeated measurement analysis of variance.The total score of HAMD-17 in the two groups decreased gradually with the extension of treatment and follow-up time(P time<0.05).The decrease in the treatment group was greater than that in the control group(P group<0.05),and the effect of treatment increased with the extension of observation time(Pinteraction<0.05).The total score of HAMA in both groups decreased gradually with the extension of treatment and follow-up time(P time<0.05).However,there was no significant difference between the two groups(P group>0.05).The score reduction rates of HAMD-17 in the treatment and control groups at the end of the fourth week were 74.29%±8.40%vs 32.54%±13.30%,respectively.At the end of the 8th week,the score reduction rates of HAMD-17 were 81.00%±10.68%vs 40.27%±12.92%,respectively.The difference was statistically significant(P<0.001).Conclusion tACS combined with antidepressants is effective and safe in the treatment of depressive episodes.It can be used as a new choice for the combined treatment of depressive episodes.