重复经颅磁刺激或无抽搐电休克治疗联合抗抑郁药物对重度抑郁障碍的疗效和安全性

Efficacy and safety profile of repetitive transcranial magnetic stimulation versus modified electroconvulsive therapy in combination with antidepressants in patients with major depressive disorder

背景重度抑郁障碍是致残性最强的精神疾病之一,目前对该病的治疗多采用药物联合物理治疗和心理治疗,关于物理治疗之间的对照研究较少,药物联合物理治疗的对照研究更少。目的探讨重复经颅磁刺激(rTMS)和无抽搐电休克治疗(MECT)分别联合抗抑郁药物对重度抑郁障碍的疗效和安全性,以期为重度抑郁障碍患者提供更优的治疗方案。方法连续选取2019年1月1日—2023年4月30日在山东省戴庄医院住院治疗的、符合《国际疾病分类(第10版)》(ICD-10)诊断标准的重度抑郁障碍患者(n=335)。入院后,患者根据病情接受MECT联合药物治疗(n=141)或rTMS联合药物治疗(n=194)。于基线期及治疗第1、2、3、4周末,采用汉密尔顿抑郁量表24项版(HAMD-24)评定抑郁症状,阅读患者病程记录,了解不良反应发生情况。结果两组HAMD-24评分的时间效应有统计学意义(F=3.081,P=0.042),组间效应无统计学意义(F=1.023,P=0.313),时间与组间的交互效应无统计学意义(F=1.642,P=0.191)。治疗后各时点,两组显效率及痊愈率比较,差异均无统计学意义(P均>0.05)。在整个治疗过程中,MECT联合药物组中,有58人(41.13%)出现近记忆力受损,74人(52.48%)出现头痛或颈部肌肉痛;rTMS联合药物组中,27人(13.92%)出现头痛或头皮不适。结论rTMS联合抗抑郁药物与MECT联合抗抑郁药物治疗重度抑郁障碍的效果相当,rTMS联合抗抑郁药物的安全性更高。

Background Major depressive disorder is one of the most disabling mental diseases.Currently,medication in combination with physiotherapy and psychotherapy remains the most commonly used treatment modality for the disease,whereas only a few randomized controlled studies have been conducted on physiotherapy,and even fewer studies have focused on medication combined with physiotherapy.Objective To explore the efficacy and safety profile of repetitive transcranial magnetic stimulation(rTMS)versus modified electroconvulsive therapy(MECT)in combination with antidepressants in the treatment of major depressive disorder,so as to provide an optimized treatment plan for patients with major depressive disorder.Methods Patients with major depressive disorder(n=335)hospitalized in Shandong Daizhuang Hospital from January 1,2019 to April 30,2023 were included,all of whom met the diagnostic criteria of the International Classification of Diseases,tenth edition(ICD-10).Depending on their disease condition,patients were subjected to either MECT in combination with drugs(n=141)or rTMS in combination with drugs(n=194)after admission.Depressive symptoms were assessed using Hamilton Depression Scale-24 item(HAMD-24)at the baseline and the end of the 1st,2nd,3rd and 4th week of treatment,and the adverse reactions were documented in patient's medical records.Results Analysis of variance on HAMD-24 revealed a significant effect of time(F=3.081,P=0.042),but no effect of group(F=1.023,P=0.313),and the interaction effect between the time and the groups was not statistically significant(F=1.642,P=0.191).No statistical difference was reported between two groups in response rate and full remission rate(P>0.05).Throughout the course of treatment,58 cases(41.13%)of recent memory impairment and 74 cases(52.48%)of headache or neck muscle pain occurred in MECT combined with drugs group,and 27 cases(13.92%)in rTMS combined with drugs group experienced headache or head skin discomfort.Conclusion Antidepressants in combination with rTMS or MECT show equivalent efficacy in the treatment of major depressive disorder,while rTMS combined with antidepressants demonstrates a superior safety profile compared to MECT.