舍曲林联合针刺治疗老年抑郁症的效果观察

目的探讨舍曲林联合针刺治疗老年抑郁症的临床疗效。方法按随机数字表法将符合《国际疾病分类(第10版)》(ICD-10)抑郁发作诊断标准的70例老年抑郁症患者分为研究组(舍曲林联合针刺治疗)和对照组(舍曲林治疗),治疗8周,采用汉密尔顿抑郁量表17项版(HAMD-17)、副反应量表(TESS)分别评定疗效和不良反应。结果 8周治疗后,研究组和对照组有效率差异无统计学意义(94.28%vs.88.57%,P0.05),治疗第1、2周末两组HAMD-17评分差异均有统计学意义[(15.25±2.36)分vs.(19.17±2.67)分,(13.25±2.36)分vs.(16.37±2.66)分,P均0.05]。两组TESS评分差异无统计学意义[(2.88±1.23)分vs.(4.97±2.69)分,P0.05]。结论舍曲林联合针刺治疗与单用舍曲林治疗对老年抑郁症均有效,但前者的早期症状改善更明显,副反应更少。     

重复经颅磁刺激与无抽搐电休克联合度洛西汀治疗难治性抑郁症对照研究

目的探讨重复经颅磁刺激(rTMS)与无抽搐电休克(MECT)联合度洛西汀治疗难治性抑郁症的疗效和安全性。方法将难治抑郁症患者60例随机分为rTMS组(rTMS+度洛西汀)30例和MECT组(MECT+度洛西汀)30例,2组均观察治疗8周,治疗前及治疗2、4、8周末用汉密尔顿抑郁量表(HAMD-24)进行评分,以减分率评定疗效。采用副反应量表(TESS)评价不良反应。结果治疗2周末MECT组HAMD总分减分率显著大于rTMS组(P0.05),4周末、8周末2组减分率差异无统计学意义(P0.05)。结论 rTMS与MECT联合度洛西汀治疗难治性抑郁症疗效相当,且rTMS组不良反应相对较轻。     

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.     

草酸艾司西酞普兰联合经颅磁刺激对青壮年卒中后抑郁的治疗研究

目的 探讨经颅磁刺激(rTMS)联合草酸艾司西酞普兰治疗青壮年卒中后抑郁(PSD)的治疗效果。方法 选取2021年6月至2023年7月就诊于保定市第一中心医院与河北省第六人民医院的的青壮年PSD患者共106例,随机分为草酸艾司西酞普兰治疗组(38例)、草酸艾司西酞普兰联合高频rTMS治疗组(32例)及草酸艾司西酞普兰联合低频rTMS治疗组(36例),经过4 w治疗后采用汉密尔顿抑郁量表17 (HAMD-17)及患者健康问卷-9 (PHQ-9)观察各组治疗效果及抑郁症状改善情况。结果经治疗后,各组HAMD-17量表评分较治疗前均有降低;除单纯草酸艾司西酞普兰治疗组外,其余两组PHQ9量表抑郁评分较治疗前均有降低。总体来说,草酸艾司西酞普兰联合rTMS治疗组评分均低于非联合治疗组,差异有统计学意义(P<0.05),但高频rTMS治疗组与低频rTMS治疗组之间差异不明显(P>0.05)。结论 草酸艾司西酞普兰联合rTMS能够降低青壮年PSD患者HAMD-17评分及PHQ-9评分,改善抑郁症状。     

重复经颅磁刺激联合认知行为治疗对老年抑郁患者成功老龄化的疗效观察

目的:观察重复经颅磁刺激(rTMS)联合认知行为治疗(CBT)对老年抑郁患者成功老龄化的疗效。方法:选取312例老年抑郁患者，随机分为对照组、CBT组、rTMS组、联合组，每组各82例。CBT组给予8周CBT,rTMS组给予4周rTMS,联合组给予4周rTMS+8周CBT。采用汉密尔顿抑郁量表(HAMD)和中文版成功老龄量表评估患者的抑郁症状和成功老龄化情况。结果:与基线期相比，4组治疗12周和1年时HAMD评分均依次降低(P均<0.05),且联合组HAMD评分均低于CBT组和rTMS组(P均<0.05);4组治疗结束后第12周和1年时成功老龄化量表功能性应对机制、内心因素和生存意义、超越老化、精神性评分及量表总分均依次升高(P均<0.05),且CBT组、rTMS组和联合组以上评分均高于对照组(P均<0.05)。结论:与rTMS或CBT单一治疗老年抑郁患者相比，二者联合更有助于改善抑郁症状、促进患者成功老龄化。     

重复经颅磁刺激治疗对卒中后抑郁障碍患者失匹配负波和视觉P300的影响

目的:探讨重复经颅磁刺激(rTMS)治疗卒中后抑郁障碍(PSD)患者事件相关电位(ERPs)中失匹配负波(MMN)和视觉P300的影响。方法:68例PSD患者根据随机数表法分为rTMS组和单用药组各34例,另选择38名志愿者为健康对照组。单用药组服用文拉法辛治疗,150 mg/d缓释顿服;rTMS组合并高频rTMS治疗6周。治疗前后给予患者汉密尔顿抑郁量表(HAMD-17)评分及ERPs中MMN、视觉P300指标检测;ERP结果与健康对照组(38名)比较。结果:治疗后两患者组HAMD-17评分均明显降低,且rTMS组治疗第3、6周后HAMD-17评分明显低于单用药组(P均0.01)。治疗前两患者组额区MMN及枕区P2、P3潜伏期明显长于健康对照组、波幅明显低于健康对照组(P均0.05);与治疗前及单用药组比较,治疗后rTMS组额区MMN潜伏期明显缩短,波幅明显升高(P均0.05);枕区P2、P3潜伏期明显缩短,P3波幅明显升高(P均0.05);单用药组治疗前后MMN、视觉P300指标比较差异无统计学意义。结论:在常规药物治疗的基础上,联合高频rTMS可以提高PSD疗效,改善患者的神经认知功能。     

双相障碍抑郁发作喹硫平碳酸锂rTMS联合治疗的疗效

目的分析喹硫平、碳酸锂、经颅磁刺激技术(transcranial magnetic stimulation,rTMS)治疗双相障碍抑郁发作的临床疗效。方法选取我院诊断为双相障碍抑郁发作患者90例,随机分为联合组(喹硫平、碳酸锂联合rTMS治疗)和药物组(喹硫平、碳酸锂治疗)。比较2组治疗前和治疗后第1、2、4、8周末HAMD-17、倍克-拉范森躁狂量表(Beeh-Rafaelsen Mania Rating scale,BRMS)和临床疗效总评量表(Clinical Global Impression,CGI)评分。结果 2组治疗后第1、2、4、8周末的HAMD-17评分、BRMS评分和CGI评分逐渐降低(P0.05);联合组治疗后第1、2、4、8周末的HAMD-17评分、BRMS评分和CGI评分低于药物组(P0.05)。结论采用喹硫平、碳酸锂药物联合rTMS治疗双相障碍抑郁发作,疗效优于单用药物治疗。     

重复经颅磁刺激对躯体形式障碍患者的临床疗效研究

目的:探讨重复经颅磁刺激(rTMS)联合度洛西汀治疗躯体形式障碍的疗效及安全性。方法:将45例躯体形式障碍患者按就诊顺序分为研究组(22例)和对照组(23例);给予两组患者口服度洛西汀(40～60 mg/d),疗程4周;在此基础上研究组联合rTMS每日1次、每周5次、共3周。治疗前及治疗后1、2、3、4周应用汉密尔顿抑郁量表(HAMD-17)减分率评定疗效,应用治疗中出现的症状量表(TESS)评定不良反应。结果:治疗后两组HAMD-17评分随时间进展明显下降,第3、4周末研究组HAMD-17评分明显低于对照组(P均0.05);研究组显效率(80.95%)明显高于对照组(56.52%)(P0.05);研究组不良反应发生率(27.3%)与对照组(43.5%)比较差异无统计学意义。结论:与单用度洛西汀治疗相比,rTMS结合度洛西汀治疗躯体形式障碍起效快、疗效优、不良反应相似。     

高频rTMS联合度洛西汀对青年首发广泛性焦虑障碍的疗效及认知功能的影响

目的探讨高频重复经颅磁刺激(rTMS)联合度洛西汀对青年首发广泛性焦虑障碍(GAD)的临床疗效、安全性及对认知功能的影响。方法将符合《国际疾病分类(第10版)》(ICD-10)广泛性焦虑障碍诊断标准的90例首发青年患者分为研究组和对照组,研究组接受高频rTMS(10 Hz)联合度洛西汀治疗,对照组接受伪经颅磁刺激联合度洛西汀治疗,观察期4周。于治疗前采用汉密尔顿抑郁量表17项版(HAMD-17)评定抑郁状况,治疗前和治疗第1、2、4周末采用汉密尔顿焦虑量表(HAMA)评定疗效,治疗前和治疗第4周末使用MATRICS共识认知成套测验(MCCB)评定认知功能,治疗第4周末采用副反应量表(TESS)评定不良反应。结果治疗后各时点,两组HAMA评分均较同组治疗前低(P均0.01)。治疗4周末,研究组治疗总有效率高于对照组(88.89%vs.73.81%,χ~2=2.100,P=0.040),研究组推理及问题解决、社会认知领域评分均高于对照组(P均0.05)。治疗后,两组TESS评分比较差异无统计学意义[(2.48±0.86)分vs.(2.14±0.78)分,χ~2=0.640,P=0.420]。结论高频rTMS联合度洛西汀对GAD的疗效更好,且有助于改善推理及问题解决、社会认知等认知功能。     

氟西汀联合坦度螺酮治疗首发抑郁症的临床研究

目的探讨氟西汀联合坦度螺酮治疗门诊首发抑郁症的效果和安全性,为提高抑郁症的疗效提供参考。方法选择佛山市顺德区伍仲佩纪念医院门诊符合《国际疾病分类(第10版)》(ICD-10)抑郁症诊断标准的首发抑郁症患者72例,按照门诊单双数病历号分为单药治疗组和联合治疗组各36例,两组均采用氟西汀治疗,联合治疗组在此基础上联用坦度螺酮,共治疗8周。于治疗前和治疗2、4、8周末采用汉密尔顿抑郁量表17项版(HAMD-17)评定疗效,于治疗2、4、8周末采用副反应量表(TESS)评定安全性。结果治疗前两组HAMD-17总评分差异无统计学意义(P0.05)。从治疗第2周末起,两组HAMD-17总评分均较同组治疗前低,差异均有统计学意义(P均0.05),且联合组与单药组HAMD-17总评分比较差异均有统计学意义(P均0.01)。治疗后各时点两组TESS评分比较差异均无统计学意义(P均0.05)。结论氟西汀联合坦度螺酮对首发抑郁症的疗效优于单用氟西汀治疗,二者安全性相当。     

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。     

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。     

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.