重复经颅磁刺激治疗伴躯体疼痛抑郁症患者的疗效观察

目的探讨重复经颅磁刺激（rTMS）治疗伴有躯体疼痛的抑郁症患者的临床疗效和安全性。方法将60例伴有躯体疼痛的抑郁症患者随机分为两组，各30例，均给予度洛西汀口服8周，研究组同时联用rTMS，对照组则予假性rTMS刺激4周，观察8周。于治疗前及治疗后第1，2，3，4，8周应用汉密尔顿抑郁量表（HAMD）、医学结局研究用疼痛量表（MOSPM）和治疗中出现的不良反应量表（TESS）评定两组的治疗效果和安全性。结果治疗结束后两组的MOSPM和HAMD评分均较治疗前显著下降（P〈0．05）；治疗第1，2，3，4周，研究组的MOSPM评分低于对照组，差异有统计学意义（P〈0．05）；治疗第2，3，4周，研究组的HAMD评分低于对照组而显效率高于对照组，差异有统计学意义（P〈0．05）；治疗第8周，两组患者的MOSPM和HAMD评分及显效率差异均无统计学意义（P〉0．05），治疗期间无严重不良反应发生。结论rTMS能有效治疗伴躯体疼痛的抑郁症，迅速缓解疼痛改善抑郁症状，早期疗效优于单一度洛西汀治疗，且安全性高。

Clinical observation of repetitive transcranial magnetic stimulation in the treatment of depression associated with somatic pain

Objective To explore the efficacy and safety of repetitive transcranial magnetic stimulation （rTMS） in the treatment of depression associated with somatic pain. Methods Sixty depressive patients associated with somatic pain were randomly divided into two groups ,both groups took duloxetine orally for 8 weeks. The study group were actively stimulated and the control group underwent sham stimulation, treatment for 4 weeks and observed for 8 weeks. Efficacy and safety were assessed with Hamilton Depression Rating Scale（HAMD）, Medical Outeonles Study Pain Measurement（MOSPM） and Treatment Emergent Symptom Scale （TESS） respectively before and after treatment for 1,2, 3, 4, 8 weeks. Results Scores of HAMD and MOSPM in the two groups decreased significantly at the end of the 8--week treatment compared with baseline （P〈 0.05）; the score of MOSPM in study group was lower than that in control group at the lst,2nd,3rd,4th weekend of the treatment （P 〈0.05）, and the score of HAMD in study group were significantly lower than that of the control group at the 2nd, 3rd,4th weekend of the treatment, there were no significant differences on HAMD and MOSPM scores at 8th weekend between the two groups （P 〈0.05）, and no serious side effects in any group during treatment. Conclusions Compared with duloxetine treat only, duloxetine combined with rTMS has better efficacy and takes effect more quickly in the treatment of depression associated with somatic pain.