有氧运动与经颅磁刺激对青少年抑郁症的临床干预效果

Effect of Aerobic Exercise and rTMS on Clinical Intervention in Adolescent Depression

目的探究4周有氧运动辅助干预对青少年抑郁症的治疗效果,比较有氧运动辅助干预与经颅磁刺激辅助干预的临床效果,探索治疗青少年抑郁症的理想方案。方法纳入北京某精神卫生专科医院2023年4—9月收治的45名青少年抑郁症患者,分为运动组(n=15)、经颅磁组(n=15)和对照组(n=15)。运动组干预方案为在药物治疗的基础上进行4周、4次/周、30min/次的中等强度有氧运动;经颅磁组干预方案为在药物治疗的基础上进行4周、4次/周的高频重复经颅磁刺激(rTMS),刺激部位为左侧DLPFC,80%运动阈值,刺激频率为10Hz,每个序列持续4s,间隔56s,持续20个序列;对照组不增加额外干预,仅进行常规药物治疗。使用中小学生心理健康诊断测试(MHT)、汉密尔顿抑郁量表(HAMD)检测患者的抑郁程度。使用威斯康星卡片分类测验(WCST)评估患者认知功能。在干预前后采集被试空腹外周血,采用酶联免疫吸附法测定患者血清内5-羟色胺(5-HT)质量浓度变化。结果干预后,3组抑郁症患者的抑郁程度均显著降低;运动组和经颅磁组的认知功能显著改善、血清5-HT质量浓度显著提升;对照组的认知功能和血清5-HT质量浓度无显著变化。在被试抑郁程度、学习、工作记忆、认知灵活性、血清5-HT质量浓度上时间和组别存在显著的交互作用,运动组和经颅磁组均显著优于对照组,但运动组与经颅磁组之间无显著差异。结论4周的有氧运动辅助干预或rTMS辅助干预可显著改善青少年抑郁症患者的抑郁症状,提升其学习、工作记忆、认知灵活性等认知功能以及血清5-HT质量浓度,且干预效果优于纯药物治疗;有氧运动辅助干预可成为rTMS辅助干预青少年抑郁症的有效替代方法。

Objective To explore the effect of 4-week aerobic exercise intervention on adolescents with depressive symptoms,compare the clinical effects of aerobic exercise intervention and rTMS,and to find the best intervention program for adolescent depression.Method The 45 adolescents with depression admitted to a specialized mental health hospital in Beijing from April 2023 to September 2023 were divided into exercise group(n=15),transcranial magnetic group(n=15)and control group(n=15).Exercise group intervention program:4 weeks,4 sessions/week,30 min/session of moderate intensity aerobic exercise based on drug treatment.Transcial intervention protocol:4 weeks,4 times/week of high frequency repeated transcranial magnetic stimulation(rTMS),stimulation site:left DLPFC,80%motion threshold,stimulation frequency 10 Hz,each sequence for 4 s,56 s interval for 20 sequences.The control group had no additional intervention and only had conventional medical therapy.Primary and secondary school Mental Health Diagnostic Test(MHT)and the Hamilton Depression Scale(HAMD)were used to test the degree of depression.The Wisconsin Card Classification Test(WCST)was used to assess patients'cognitive function.Fasting peripheral blood was collected before and after the intervention,and the serum mass concentration change of serotonin(5-HT)was measured by enzyme-linked immunosorbent assay.Results After the intervention,depressive symptoms of three groups were all significantly relieved.The cognitive function was significantly improved in exercise group and rTMS group,so was the serum 5-HT mass concentration;while no significant changes were found in the control group.There were significant interactions between participants on depression,learning,working memory,cognitive flexibility,and serum 5-HT mass concentration,and the exercise and rTMS groups were significantly better than the control group,but no significant difference between the exercise and rTMS groups.Conclusion Four weeks of aerobic exercise assisted intervention or rTMS assisted intervention can significantly reduce depressive symptoms in adolescent patients with depression,improve cognitive functions such as learning,working memory,cognitive flexibility and serum 5-HT mass concentration,and the intervention effect is better than pure drug therapy.Aerobic exercise assisted intervention can be an effective alternative to rTMS assisted intervention in adolescent depression.