低频重复经颅磁刺激联合阿戈美拉汀对大学生抑郁症急性发作伴失眠障碍的疗效研究

Study on Therapeutic Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation Combined with Agomelatine on Acute Depressive Disorder with Insomnia in College Students

目的 观察低频(1 Hz)重复经颅磁刺激(rTMS)联合阿戈美拉汀对大学生抑郁症急性发作伴失眠障碍的疗效。方法 选取2020年11月至2021年11月在武汉市精神卫生中心就诊的大学生抑郁症急性发作伴失眠障碍者共90例,采用随机数字表法分为3组,rTMS组给予低频rTMS和安慰剂治疗,阿戈美拉汀组给予阿戈美拉汀和假刺激治疗,联合组给予低频rTMS和阿戈美拉汀治疗,每组各30例。研究为期6周,比较3组干预前后汉密尔顿抑郁量表(HAMD)和匹兹堡睡眠质量指数量表(PSQI)评分情况。结果 经重复测量方差分析,结果显示,组别与时间交互作用差异有统计学意义(P<0.001)。单因素方差分析结果显示,HAMD评分与PSQI评分基线差异无统计学意义(P>0.05),干预后第2、4、6周组间比较,差异有统计学意义(P<0.001);进一步两两比较,干预后第2、4、6周联合组评分均低于阿戈美拉汀组与rTMS组(P<0.05)。干预后第2、4、6周HAMD评分与PSQI评分下降值组间比较,差异有统计学意义(P<0.001);进一步两两比较,干预后第2、4、6周联合组评分下降值均高于阿戈美拉汀组与rTMS组(P<0.05)。结论 低频rTMS联合阿戈美拉汀用于大学生抑郁症急性发作伴失眠障碍的疗效优于单用阿戈美拉汀或低频rTMS。

Objective To observe the therapeutic effects of low frequency(1Hz) repetitive transcranial magnetic stimulation(rTMS) combined with agomelatine on acute depressive disorder accompanied by insomnia in college students.Methods A total of 90 college students with depressive disorder and insomnia who received treatment in Wuhan Mental Health Center from November 2020 to November 2021 were selected and divided into 3 groups by random number table method. The rTMS group(n=30) was given low frequency rTMS and placebo treatment;The agomelatine group(n=30) was given agomelatine and sham stimulation;And the combination group(n=30) was treated with low frequency rTMS and agomelatine. The treatment lasted for 6 weeks. Scores of Hamilton Depression Scale(HAMD) and Pittsburgh Sleep Quality Index(PSQI) before and after intervention were compared among the 3 groups. Results Analysis of repeated measures of variance showed a statistically significant interaction between group and time(P< 0.001). The results of oneway analysis of variance showed that there was no significant difference in the HAMD score and the PSQI score at baseline among the three groups(P> 0.05),but there were significant differences in the HAMD score and the PSQI score among the 3 groups at the 2nd,4th and 6th week after intervention(P< 0.001). Further pairwise comparison showed that the HAMD score and the PSQI score at the 2nd,4th and 6th week after intervention in the combination group were lower than those in the agomelatine group and the rTMS group(P< 0.05). There were statistically significant differences among the 3groups in the decrease of the HAMD score and the PSQI score at the 2nd,4th and 6th week after intervention(P< 0.001).Further pairwise comparison showed that at the 2nd,4th and 6th week after intervention,the decline of the HAMD score and the PSQI score in the combination group were greater than those in the agomelatine group and the rTMS group(P< 0.05). Conclusion Low frequency rTMS combined with agomelatine is better than agomelatine alone or low frequency rTMS alone in the treatment of acute depressive disorder with insomnia in college students.