rTMS与MECT对难治性抑郁症疗效及认知功能影响的随机对照研究

目的 比较抗抑郁药联合重复经颅磁刺激(rTMS)或无抽搐电休克(MECT)治疗难治性抑郁症的疗效,并探讨两者对抑郁症患者认知功能的影响.方法 将40例难治性抑郁症患者随机分成rTMS治疗组和MECT治疗组,分别于治疗前、治疗1周、2周应用汉密尔顿抑郁量表(HAMD)和临床记忆量表评定临床疗效及认知功能改变,采用不良反应量表(TESS)、生命体征、体格检查、心电图、脑电图评价安全性.结果 两组患者HAMD总分、认知障碍因子分在治疗1周、2周差异无统计学意义(P>0.05);治疗2周后,rTMS组总分及各因子评分均较治疗前提高(P<0.05),MECT组指向记忆、无意义图形再认、人像特点回忆评分较治疗前明显下降(P<0.05);治疗后两组间比较,MECT组患者的临床记忆量表总分、指向记忆、图像自由回忆、人像特点回忆评分均显著低于rTMS组,差异有统计学意义(P<0.05).治疗中两组恶心、呕吐、头痛发生率的差异无统计学意义(P>0.05),MECT组主诉记忆力下降者比例高于rTMS组(P<0.05).结论 rTMS与MECT治疗难治性抑郁症疗效相当,rTMS对认知功能的改善作用优于MECT.

Comparison of antidepressive effect and cognitive imfluence between repetitive transcranial magnetic stimulation and modified electroconvulsive therapy for medication-resistant depression: a randomized,controlled trial

Objective To compare the antidepressive effect and cognitive imfluence of modified electroconvulsive therapy(MECT) and repetitive transcranial magnetic stimulation(rTMS) on medica-tion-resistant depression patients.Methods Totals of 40 patients with treatment-refractory and non-psy-chotic major depression were randomly divided into MECT group and rTMS group. They received two weeks of treatments with either MECT or rTMS and were assessed for efficacy and cognitive impairments before and after 1 and 2 weeks treatment by Hamilton Rating Scale for Depression(HAMD) and Clinical Memory Scale. Treat-ment Emergent Symptom Scale(TESS) was used to evaluate the side-effects. Moreover, medical examination, electrocardiogram and electroencephalogram examination were performed before and after treatment for safety. Results There was no difference between two groups before and at the end of week 1 and 2 on the total HAMD score(P=0.610,P=0.235) and cognitive impairment factors(P=0.639,P=0.793). However, Clinical Memo-ry Scale score and all factors of rTMS group was improved markedly at the end of week 2(P<0.05). Directed memory score, free recall deficit of picture score, image free recall score and portrait character recall score of MECT group was declined at the end of week 2(P<0.05). And the total score, directed memory score and por-trait character recall score of MECT group was lower than that of rTMS group(P<0.05). There was no significant difference between the two groups on the incidence of nausea, vomiting, headache(P>0.05), and more patients complained of memory decline in the MECT group(P<0.05).Conclusions rTMS and MECT have similar effi-cacy in treating treatment-refractory non-psychotic major depression. But rTMS is benefit to the improvement of cognitive performance with more safety than MECT.