重复经颅磁刺激联合艾司西酞普兰治疗首发抑郁发作的研究

Clinical Trial of Repetitive Transcranial Magnetic Stimulation Combined with Escitalopram in the Treatment of First-episode Depression

目的探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合艾司西酞普兰治疗军人首发抑郁发作的疗效。方法将33例军人首发抑郁发作患者随机分为实验组(n=16)和对照组(n=17),两组在为期4周的治疗观察期内均给予艾司西酞普兰固定剂量10 mg治疗。实验组在药物治疗起始同时辅以rTMS连续治疗2周,对照组按相同程序给予sham-rTMS治疗。采用17项汉密尔顿抑郁量表(Hamilton's depression scale,HAMD-17)评定疗效,治疗中用副反应量表(treatment emergent symptom scale,TESS)评定不良反应。结果重复测量方差分析结果显示,组别的主效应不显著(F=2.85,P>0.05),测量时间的主效应显著(F=434.56,P<0.05),组别和时间存在交互作用(F=10.73,P<0.05)。2周rTMS治疗结束时,实验组的治疗有效率显著高于对照组(P<0.05),而4周观察期结束时,两组治疗有效率差异无统计学意义(P>0.05)。两组均未出现明显副反应。结论 rTMS联合药物治疗军人首发抑郁发作,治疗存在时限性,但与单纯药物治疗相比,可增强疗效。

Objective To evaluate the efficacy of Repetitive Transcranial magnetic stimulation(rTMS)combined Escitalopram in the treatment of first-episode depression in military personnel.Methods Thirty-three subjects with firstepisode major depression were randomly divided into rTMS group(n=16)and control group(n=17).A fixed dose of Escitalopram10 mg per day during the whole 4 weeks of observation for both groups.The rTMS group accompanied with2 sessions of active rTMS for two weeks in the initial treatment,while the control group performed sham rTMS as the same protocol.The 17-item hamilton depression scale(HAMD-17)was applied to assess the therapeutic effect and treatment emergent symptom scale(TESS)to evaluate the adverse reactions of the two groups.Results A mixed-model ANOVA was used to analyze the score of HAMD-17.Repetitive measurement deviation analysis showed that the main effect of group was not significant(F=2.85,P>0.05).However,there was significant main effect of time(F=434.56,P<0.05)and significant interaction between group and time(F=10.73,P<0.05).The effective rate of the rTMS group was significantly higher than the control group at the 2-week(P<0.05).Nevertheless,there was no significant difference in the effective rate between the rTMS and control group at the 4-week(P>0.05).No obvious side effects of both groups were observed.Conclusion Compared with pure drug therapy,rTMS combined with antidepressants in the treatment of first-episode depression in military personnel can enhance curative effect but with time limits.