无抽搐电休克联合SSRI治疗对重度抑郁症患者认知功能的影响

Effect of modified electric convulsive therapy combined with SSRIS on cognitive function in patients with severe depression

目的探讨无抽搐电休克(MECT)联合五羟色胺再摄取抑制剂(SSRI)治疗对重度抑郁症患者认知功能的影响。方法采用前瞻性、单盲、随机对照的初步试验,选取2022年6月至2023年6月在广东中能建电力医院住院的重度抑郁症患者50例,按随机数字表法分为观察组(25例)和对照组(25例)。其中,观察组男14例,女11例,年龄(35.32±3.66)岁,病程(7.56±1.45)个月;对照组男10例,女15例,年龄(34.98±3.09)岁,病程(8.12±1.26)个月。观察组使用MECT(每周3次,疗程为4周)和SSRI类药物(舍曲林100~200 mg/d,疗程为2周)联合治疗,对照组仅使用和观察组相同的SSRI类药物治疗。比较两组患者治疗前和治疗后第2、4周抑郁情况(HAMD-24)、执行能力(WCST)、记忆功能(WAIS-RC)及决策能力(IGT)的差异,组间比较采用独立样本t检验、χ2检验。结果在治疗后第2周、4周,观察组HAMD-24总分分别为(23.61±3.27)分、(18.43±5.22)分,均低于对照组[(29.41±3.13)分、(21.63±5.32)分],两组比较差异均有统计学意义(均P<0.05)。在治疗后第4周,观察组WSCT中完成分类数为(6.13±2.01)分,高于对照组(5.21±1.72)分,但两组比较差异无统计学意义(P>0.05)。在治疗后第2周,观察组WAIS-RC总分(10.51±3.50)分、正序分(8.64±1.24)分、逆序分(3.16±1.21)分,均低于对照组的(13.67±4.13)分、(11.22±2.21)分、(4.20±1.15)分(均P<0.05)。在治疗后第2周,观察组总净得分(1.63±0.21)分,高于对照组的(1.27±0.56)分(P<0.05);治疗后第4周,观察组总净得分(2.64±1.21)分,高于对照组的(1.67±0.74)分(P<0.05)。结论MECT联合SSRI类药物治疗对重度抑郁症患者效果显著,能够有效改善其认知功能,效果优于单药治疗,MECT对患者工作与记忆功能存在短暂影响,但随着时间延长患者工作与记忆功能可恢复。

Objective To investigate the effect of modified electric convulsive therapy(MECT)combined with serotonin reuptake inhibitors(SSRI)on cognitive function in patients with severe depression.Methods A total of 50 patients with severe depression admitted to Guangdong Zhongnengjian Dianli Hospital from June 2022 to June 2023 were selected for the randomized controlled trial,and were divided into an experimental group and a control group by the random number table method,with 25 cases in each group.There were 14 males and 11 females in the experimental group;they were(35.32±3.66)years old;their disease course was(7.56±1.45)months.There were 10 males and 15 females in the control group;they were(34.98±3.09)years old;their disease course was(8.12±1.26)months.The experimental group took MECT 3 times a week for 4 weeks and SSRI sertraline 100-200 mg/d for 2 weeks,while the control group only took sertraline.The scores of Hamilton Depression Scale(HAMD-24),Wisconsin Card Sorting Test(WCST),Wechsler Adult Intelligence Scale(WAIS-RC),and Iowa Gambling Task(IGT)before the treatment and after 2 and 4 weeks'treatment were compared between the two groups by the independent-sample t test and χ^(2) test.Results The scores of HAMD-24 after 2 and 4 weeks'treatment in the observation group were lower than those in the control group[(23.61±3.27)vs.(29.41±3.13)and(18.43±5.22)vs.(21.63±5.32)],with statistical differences between the two groups(both P<0.05).After 4 weeks'treatment,the score of the number of completed classification in WSCT of the observation group was significantly higher than that of the control group[(6.13±2.01)vs.(5.21±1.72)],with no statistical difference between the two groups(P>0.05).The total score and the scores of positive and negative sequences of WAIS-RC after 2 weeks'treatment in the observation group were lower than those in the control group[(10.51±3.50)vs.(13.67±4.13),(8.64±1.24)vs.(11.22±2.21),and(3.16±1.21)vs.(4.20±1.15);all P<0.05].The total net scores after 2 and 4 weeks'treatment in the observation group were higher than those in the control group[(1.63±0.21)vs.(1.27±0.56)and(2.64±1.21)vs.(1.67±0.74);both P<0.05].Conclusion MECT combined with SSRI for patients with severe depression is more effective than SSRI monotherapy,and can effectively improve their cognitive function,and has short-term effect on their working and memory function,but with the extension of time,their working and memory function will restore.