不同频率重复经颅磁刺激治疗脑卒中后抑郁障碍的疗效分析

目的分析不同频率重复经颅磁刺激治疗脑卒中后抑郁障碍的临床疗效。方法采用随机数字表法将我院收治的95例脑卒中后抑郁障碍患者进行分组,对照组47例给予低频率经颅磁刺激治疗,观察组48例给予高频率经颅磁刺激治疗,观察2组治疗前后抑郁状态及神经功能缺损情况。结果观察组HAMD评分、神经功能缺损程度优于对照组,差异均有统计学意义(P0.05)。结论重复经颅磁刺激通过不同刺激频率,兴奋或抑制大脑皮质以产生作用,改善患者的神经功能及抑郁症状效果确切,安全性高,其中高频率重复经颅磁刺激改善患者的神经功能及抑郁症状效果更优,值得临床推广。     

重复经颅磁刺激联合舍曲林对精神分裂症后抑郁影响的随机对照研究

目的探讨重复经颅磁刺激(r TMS)联合舍曲林对精神分裂症后抑郁的疗效及认知功能的影响。方法采用随机数字表法将符合《国际疾病分类(第10版)》(ICD-10)精神分裂症后抑郁诊断标准的78例患者分为观察组和对照组各39例,对照组采用舍曲林治疗,观察组在对照组治疗方案的基础上辅用r TMS治疗,两组均于治疗前及治疗6周后采用汉密尔顿抑郁量表(HRSD)、Herth希望指数量表(HHI)、威斯康辛卡片分类测验(WCST)进行测评。结果治疗后,两组HRSD评分均低于治疗前(t=34.212,26.631,P0.01),且观察组低于对照组(t=6.705,P0.01);治疗后两组HHI总分及各项因子评分高于治疗前(t=6.737,6.245,11.008,6.403,P0.01),两组HHI总分及各项因子评分比较差异均有统计学意义(t=3.184,2.799,4.265,2.855,P0.01);治疗后观察组WCST评分较治疗前差异有统计学意义(t=20.399,18.558,5.101,5.894,15.385,P0.01),观察组WCST评分较对照组差异有统计学意义(t=11.900,10.614,3.739,3.573,6.229,P0.01)。结论重复经颅磁刺激合并舍曲林可能提高精神分裂症后抑郁的疗效及心理希望水平,改善患者的认知功能。     

重复经颅磁刺激与帕罗西汀联合治疗对焦虑抑郁障碍患者的疗效及认知功能影响

目的研究重复经颅磁刺激联合帕罗西汀在焦虑抑郁障碍患者中的临床治疗效果及对患者认知功能的影响。方法选取2014年1月~2016年5月医院诊治的焦虑抑郁障碍患者90例,将患者随机分为对照组(45例)和观察组(45例)。对照组采用帕罗西汀治疗,观察组予以帕罗西汀联合重复经颅磁刺激治疗。采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表17项(HAMD-17)和临床疗效总评量表(CGI)总分变化评定疗效,采用事件相关电位(P300)及眼动测定患者认知功能。结果观察组治疗4周有效率为95.6%,显著高于对照组的80.0%(P0.05);两组治疗前HAMA量表评分、HAMD量表差异无统计学意义(P0.05),治疗后上述量表评分均逐渐地明显降低(P0.05);且观察组患者治疗后2周、4周HAMA量表、HAMD量表评分,显著低于对照组(P0.05);观察组治疗后P300的潜伏期,显著低于对照组(P0.05);观察组治疗后P300波幅及眼动测定NEF和RSS,显著高于对照组(P0.05)。结论焦虑抑郁障碍患者中采用重复经颅磁刺激联合帕罗西汀治疗比帕罗西汀单药治疗效果更理想,能更好地改善患者认知功能。     

经颅直流电刺激联合盐酸舍曲林对老年抑郁症患者的疗效、认知功能及血清脑源性神经营养因子水平的影响

目的:探讨经颅直流电刺激(tDCS)联合盐酸舍曲林对老年抑郁症患者的疗效及对认知功能和血清脑源性神经营养因子(BDNF)水平的影响.方法:62例老年抑郁症患者随机分为tDCS组和伪tDCS组;两组在舍曲林治疗基础上分别给予真、伪tDCS治疗4周.分别于治疗前及治疗后1、2、4周末进行汉密尔顿抑郁量表(HAMD)、治疗中...     

低频重复经颅磁刺激治疗脑卒中后焦虑抑郁共病的疗效

目的研究低频重复经颅磁刺激(rTMS)治疗脑卒中后焦虑抑郁共病的疗效。方法选取卒中后焦虑抑郁共病患者64例,随机为对照组及观察组。对照组采用传统药物方式治疗,观察组在对照组的基础上联合低频重复经颅磁刺激方式治疗。对比2组患者HAMD评分、HAMA评分情况以及治疗总有效率。结果 HAMD评分及HAMA评分从治疗第5天开始观察组均明显低于对照组。对照组有效率为75%,观察组为93.75%,差异有统计学意义(P0.05)。结论低频重复经颅磁刺激方式治疗可明显缓解脑卒中后出现焦虑抑郁障碍患者抑郁、焦虑程度,具有临床推广价值。     

帕罗西汀、低频重复经颅磁刺激联合心理干预对伴焦虑的抑郁症患者的效果分析

目的 探讨在伴焦虑的抑郁症患者进行治疗的过程中,选择帕罗西汀、低频重复经颅磁刺激联合心理干预的效果。方法 由研究人员选择2020年1月～2022年1月这一时间范围内,在我院通过相关检查由医师确诊为抑郁症的80例患者,均存在焦虑及抑郁症状,以入院单双数分组后每组40例,对照组纳入的患者实施帕罗西汀治疗,观察组纳入的患者在对照组基础上实施帕罗西汀、低频重复经颅磁刺激联合心理干预。统计治疗后两组患者的疗效和不良反应。结果 观察组40例患者经帕罗西汀联合低频重复经颅磁刺激治疗后,评估显示的焦虑结果,较对照组明显降低;焦虑/躯体化、绝望感、躯体焦虑、精神焦虑、自杀、抑郁情绪评分低于对照组（P<0.05）;观察组记录的临床疗效,较对照组明显升高（P<0.05）;观察组记录的不良反应发生率,较对照组无明显变化（P>0.05）。结论 在对伴焦虑症状的抑郁症治疗中,选择帕罗西汀、低频重复经颅磁刺激联合心理干预的方案可明显改善其焦虑、抑郁症状,同时可确保治疗安全性及有效性。     

舍曲林联合心理治疗对糖尿病伴抑郁的疗效观察

目的 探讨舍曲林联合心理治疗对糖尿病伴抑郁的疗效.方法 将82例伴抑郁症状的DM患者随机分为舍曲林联合心理治疗组(联合组)和单用舍曲林组(舍曲林组),疗程8 周,采用汉密尔顿抑郁量表(HAMD)及副反应量表(TESS),随访半年并进行临床疗效评定.结果 治疗后第2周末、第8周末2组HAMD评分有显著性差异(P<0.05),随访半年后联合组的显效率为85.0%,舍曲林组为55.3%,2组相比有显著性差异(P<0.05).结论 舍曲林联合心理治疗对糖尿病伴抑郁疗效确切、持久.     

重复经颅磁刺激联合认知行为疗法对帕金森病非运动症状的疗效

目的评价重复经颅磁刺激联合认知行为疗法对帕金森病非运动症状的疗效。方法选取2014-02—2016-03我院收治的帕金森病患者67例,随机分为2组,其中观察组34例选用重复经颅磁刺激联合认知行为疗法进行治疗,对照组33例仅选用认知行为疗法进行治疗,观察并比较2组患者治疗后HAMD(汉密尔顿抑郁量表)、HAMA(汉密尔顿焦虑量表)(PSQI)及匹兹堡睡眠质量指数。结果治疗后,观察组HAMD评分为(7.32±0.47)分,HAMA评分为(5.59±0.34)分,对照组HAMD评分为(11.22±1.79)分,HAMA评分为(8.49±1.23)分,观察组HAMD、HAMA评分均明显低于对照组,差异有统计学意义(P0.05);在PSQI评分方面,观察组PSQI总分明显低于对照组,差异有统计学意义(P0.05)。结论重复经颅磁刺激联合认知行为疗法对于帕金森病非运动症状具有较好的疗效,能够有效减轻患者焦虑、抑郁症状,提高睡眠质量,值得临床推广应用。     

舍曲林联合经颅磁刺激对急性脑梗死后患者神经缺损的影响

目的：探讨对首发脑梗死患者早期应用舍曲林联合经颅磁刺激是否利于神经功能缺损状态的改善,并减少卒中后抑郁的发生。方法将200例首发急性脑卒中患者随机分为对照组、舍曲林组、经颅磁刺激（TMS）组、舍曲林＋ TMS组,对照组为空白对照,4组均接受抗血小板聚集、调脂、改善循环、脑保护等常规治疗,分别应用NIHH评分、ADL评分、汉密顿抑郁量表（HAMD）评价患者入院时、发病12周后神经功能缺损状态、日常生活能力、抑郁状态。结果发病12周后NIHH、ADL、HAMD评分,对照组与舍曲林组、TMS组、舍曲林＋ TMS组间差异均有统计学意义（P＜0·05）,舍曲林组、TMS组与舍曲林＋ TMS组间差异有统计学意义（P＜0·05）。结论舍曲林、TMS均可改善患者的神经功能缺损症状,减少卒中后抑郁的发生,二者联合作用优于单个作用。     

重复经颅磁刺激治疗脑卒中后癫痫合并焦虑抑郁患者的效果

目的观察重复经颅磁刺激治疗脑卒中后癫痫合并焦虑抑郁患者的效果。方法将93例脑卒中后癫痫合并焦虑抑郁患者随机分组,对照组46例予常规药物治疗,观察组47例联合重复经颅磁刺激,对比两组患者焦虑抑郁情绪、神经功能、神经递质、血液流变学变化及不良事件发生率。结果观察组治疗后NE水平高于对照组,HAMD、HAMA、NIHSS评分及Fib、PAl、LSV、HSV、ηs、5-HT水平均低于对照组(P0.05);不良事件发生率低于对照组(P0.05)。结论重复经颅磁刺激能够有效改善脑卒中后癫痫合并焦虑抑郁患者的情绪和神经递质及血液流变学水平。     

低频重复经颅磁刺激治疗首发抑郁症的临床对照研究

目的探讨低频重复经颅磁刺激(rTMS)治疗首发抑郁症的疗效及安全性。方法采用随机数字表法将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的65例首发抑郁症患者分为rTMS组33例和氟西汀组32例,观察期6周。用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)及副反应量表(TESS)分别评定疗效及不良反应。结果 rTMS组有效率78.8%,氟西汀组有效率84.4%,两组疗效相当(P0.05);在第1周末rTMS组HAMD-17和HAMA评分较氟西汀组低,差异有统计学意义(P均0.05);rTMS组和氟西汀组不良反应发生率分别为12.1%和40.6%,差异有统计学意义(P0.01)。结论 rTMS治疗首发抑郁症的效果与氟西汀相当,但起效较氟西汀快、不良反应发生率低于氟西汀。     

Long-lasting effects of high frequency repetitive transcranial magnetic stimulation in major depressed patients

The majority of previous clinical studies have indicated that repetitive transcranial magnetic stimulation (rTMS) may have antidepressant effects. Herein, we investigated the longitudinal, long-term antidepressant efficacy of daily left prefrontal cortex (PFC) rTMS for a 1-week period. Nineteen patients were randomly assigned to two treatment groups at 90% of individual motor threshold (MT): Twelve received active repetitive transcranial magnetic stimulation and seven received sham treatment. Each patient underwent five sessions of twenty 2-s trains of 20 Hz rTMS with 800 stimuli/day. The Beck Depression Inventory and the Hamilton Depression Rating Scale were used to assess severity of depression at 1, 4 and 12 weeks post-therapy. A significant reduction of baseline depression scores was observed after 1 week of active treatment that lasted for 1 month, indicating improvement of depressive symptoms. No significant effects were observed in patients receiving sham treatment. The results of this controlled study are in agreement with the findings of previous studies suggesting that daily left PFC rTMS has an antidepressant effect.     

高频重复经颅磁刺激联合文拉法辛治疗抑郁症的早期疗效

目的:探讨高频重复经颅磁刺激(20HzrTMS)联合文拉法辛治疗抑郁症的早期疗效与安全性。方法:将40例抑郁症患者随机分为研究组(n=20例)和对照组(n=20例)。研究组给予20HzrTMS联合文拉法辛治疗,对照组单用文拉法辛联合假rTMS治疗。观察6周。两组分别于治疗前和治疗2、4、6周采用汉密尔顿抑郁量表(HAMD)评定疗效;采用治疗中出现的症状量表(TESS)评定不良反应。结果:两组治疗后HAMD评分均有显著下降(P<0.05);以研究组在治疗2、4周时降分显著(P<0.05)。两组间部分不良反应发生率存在统计学意义(P<0.05)。结论:高频重复经颅磁刺激联合文拉法辛治疗抑郁症早期疗效优于单一用药,不良反应发生率较低。     

Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson's disease

OBJECTIVE: To study the efficacy of 15 Hz repetitive transcranial magnetic stimulation (rTMS) in treating depression in patients with Parkinson's disease. METHODS: 42 patients were enrolled into two groups: group 1, active rTMS (15 Hz rTMS for 10 days) and placebo drug treatment; group 2, sham rTMS and fluoxetine 20 mg/day. A specially designed sham coil was used for sham stimulation. The unified Parkinson's disease rating scale (UPDRS), activities of daily living (ADL), Hamilton rating scale for depression (HRSD), Beck depression inventory (BDI), and mini-mental state examination (MMSE) were assessed by a rater blinded to treatment arm. RESULTS: HRSD and BDI were improved to the same extent in both groups after two weeks of treatment (38% and 32% for group 1, 41% and 33% for group 2, respectively). At week 8 there was a tendency for worse motor UPDRS scores in group 2 (NS). ADL showed improvement at week 8 only in group 1. MMSE improved in both groups after treatment, but faster in group 1 than in group 2. There were fewer adverse effects in group 1 than in group 2. CONCLUSIONS: rTMS has the same antidepressant efficacy as fluoxetine and may have the additional advantage of some motor improvement and earlier cognitive improvement, with fewer adverse effects.     

左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁患儿的疗效观察

目的 探讨左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁症儿童的临床疗效。方法 回顾性分析112例6~15岁癫痫伴抑郁症的临床资料,按年龄分为学龄组（6~12岁,56例）和少年组（13~15岁,56例）,评估治疗前后癫痫发作频率、认知功能（WISC-CR）、汉密尔顿抑郁量表17项（HAMD-17）、生活质量、身体质量指数（BMI）、不良反应发生率。结果 与治疗前相比,两组治疗6、12个月,癫痫发作频率、认知功能、HAMD-17评分、生活质量均显著改善（P<0.05）;同时,学龄组癫痫发作频率、认知功能、HAMD-17评分、生活质量均显著优于少年组（P<0.05）;两组治疗后BMI、不良反应发生率无统计学差异（P>0.05）。结论 采用左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁症儿童可获得显著的疗效,其中学龄组疗效优于少年组。     

Prefrontal repetitive transcranial magnetic stimulation as add on treatment in depression

A growing number of studies report antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) in patients with major depression. The hypothesis that high frequency (20 Hz) rTMS (HF-rTMS) may speed up and strengthen the therapeutic response to sertraline in MD was tested. Twenty eight patients who had not yet received medication for the present depressive episode (n=12) or had failed a single trial of an antidepressant medication (n=16) were started on sertraline and randomised to receive either real of sham HF-rTMS. HF-rTMS was applied to the left dorsolateral prefrontal area in daily sessions (30 trains of 2 s, 20-40 s intertrain interval, at 90% motor threshold) on 10 consecutive working days. The results suggest that in this patient population, HF-rTMS does not add efficacy over the use of standard antidepressant medication.     

重复经颅磁刺激与消郁汤辅助治疗首发抑郁症的临床对照研究

目的 探讨重复经颅磁刺激（r TMS）与中药消郁汤辅助治疗首发抑郁症的临床疗效和安全性。方法 139例首发抑郁症患者随机分为文拉法辛合并r TMS（研究组A）治疗40例、文拉法辛合并消郁汤（研究组B）治疗54例和单纯文拉法辛治疗组45例（对照组）。治疗前及治疗后第1、2、4周末,采用汉密尔顿抑郁量表（HAMD）和治疗中需处理的不良反应症状量表（TESS）进行评定。结果 治疗后第1、2、4周末,3组患者HAMD评分较治疗前降低（P〈0.05）;研究组A和研究组B HAMD评分在治疗后第1、2周末均低于对照组（P〈0.05）;治疗后第4周末,研究组A与研究组B HAMD评分与对照组比较差异无统计学意义（P〉0.05）。3组不良反应发生率比较差异无统计学意义（P〉0.05）。结论 抗抑郁药物合并重复经颅磁刺激或中药消郁汤辅助治疗首发抑郁症比单纯药物治疗早期疗效好,能迅速缓解症状,安全性高。     

A型肉毒毒素联合重复经颅磁刺激治疗眼睑痉挛合并焦虑抑郁的临床观察

目的 观察肉毒毒素联合重复经颅磁刺激治疗对眼睑痉挛合并焦虑抑郁的治疗效果。方法 纳入良性特发性眼睑痉挛(Benign essential blepharospasm,BEB)伴焦虑/抑郁患者63例,其中单纯A型肉毒毒素(Botulinum toxin A,BTX-A)注射治疗组28例,肉毒毒素联合重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)治疗组35例,随访6个月; 在治疗前后通过Cohen Albert标准分级、眨眼次数及患者满意程度评价总体疗效; 通过SDS和SAS量表评分评估患者抑郁焦虑情况; 比较2组疗效、起效时间、持续时间及焦虑抑郁量表评分。结果 单纯BTX-A治疗和联合rTMS治疗均能明显改善患者症状,有效率分别为92.86%、94.29%(P>0.05); 单纯BTX-A治疗组的疗效持续时间为(13.04±3.48)周,联合rTMS治疗组的疗效持续时间为(16.89±3.39)周(P<0.01); 单纯BTX-A治疗组及联合rTMS治疗组治疗前SDS评分分别为(62.19±5.77)、(63.50±7.97)分(P>0.05),SAS评分分别为(66.07±9.43)、(64.89±8.38)分(P>0.05); 单纯BTX-A治疗组及联合rTMS治疗组治疗2个月后SDS评分分别为(49.69±7.90)、(49.46±6.73)分(P>0.05),SAS评分分别为(53.88±7.34)、(48.79±6.62)分(P<0.05)。结论 A型肉毒毒素联合重复经颅磁刺激治疗能有效提高特发性眼睑痉挛患者的疗效,延长眼睑痉挛缓解持续的时间,明显改善抑郁焦虑,特别是对减轻患者焦虑明显优于单纯BTX-A治疗。     

Efficacy and safety of the Chinese herbal medicine shuganjieyu with and without adjunctive repetitive transcranial magnetic stimulation (rTMS) for geriatric depression: a randomized controlled trial

Background

Pharmacological treatment of geriatric depression is often ineffective because patients cannot tolerate adequate doses of antidepressant medications.

Aim

Examine the efficacy and safety of shuganjieyu – the first Chinese herbal medicine approved for the treatment of depression by China’s drug regulatory agency -- with and without adjunctive treatment with repetitive transcranial magnetic stimulation (rTMS) in the treatment of geriatric depression.

Methods

Sixty-five inpatients 60 or older who met ICD-10 criteria for depression were randomly assigned to an experimental group (shuganjieyu + rTMS) (n=36) or a control group (shuganjieyu + sham rTMS)(n=29). All participants received 4 capsules of shuganjieyu daily for 6 weeks. rTMS (or sham rTMS) was administered 20 minutes daily, five days a week for 4 weeks. Blinded raters used the Hamilton Rating Scale for Depression (HAMD-17) and the Treatment Emergent Symptom Scale to assess clinical efficacy and safety at baseline and 1, 2, 4, and 6 weeks after starting treatment. Over the six-week trial, there was only one dropout from the experimental group and two dropouts from the control group.

Results

None of the patients had serious side effects, but 40% in the experimental group and 50% in the control group experienced minor side effects that all resolved spontaneously. Both groups showed substantial stepwise improvement in depressive symptoms over the 6 weeks. Repeated measures ANOVA found no differences between the two groups. After 6 weeks, 97% of the experimental group had experienced a 25% or greater drop in the level of depression, but only 20% had experience a 50% or greater drop in the level of depression; the corresponding values in the control group were 96% and 19%. There were some minor, non-significant differences in the onset of the treatment effect between the different types of depressive symptoms, but by the second week of treatment all five HAMD-17 subscale scores had improved significantly in both groups

Conclusion

The Chinese herbal medicine shuganjieyu is effective and safe in the treatment of geriatric depression, but only a minority of patients have greater than 50% improvement in their depressive symptoms after 6 weeks of treatment. Adjunctive use of rTMS with shuganjieyu does not improve the overall outcome and does not significantly speed up the onset of action of shuganjieyu.