文拉法辛缓释胶囊联合MECT对中重度抑郁发作的效果及认知功能的影响

目的比较文拉法辛缓释胶囊联合改良电休克治疗(MECT)与单用文拉法辛缓释胶囊对中重度抑郁发作的效果和认知功能的影响。方法纳入符合《国际疾病分类(第10版)》(ICD-10)抑郁发作诊断标准的患者160例,按照随机数字表法分为文拉法辛缓释胶囊联合MECT组(研究组)和单用文拉法辛缓释胶囊治疗组(对照组)各80例。两组文拉法辛起始剂量为75 mg/d,根据患者疾病状况及耐受性,剂量可加至225 mg/d。研究组在药物治疗的同时进行共8次MECT:第1周每日1次,连续治疗5次;第2周隔日1次,治疗3次。研究周期共4周。于基线期和治疗第2、4周末采用汉密尔顿抑郁量表17项版(HAMD-17)评定两组患者抑郁症状,采用威斯康星卡片分类测试(WCST)评定研究组认知功能。结果治疗第2、4周末,两组HAMD-17评分均较同组治疗前低(t=2.846～9.803,P均0.01);治疗2周末,研究组HAMD-17评分低于对照组(t=2.070,P0.05),研究组WCST的总应答数、完成分类、错误应答数、概念化、非持续错误及学习到学会评分均较治疗前高(t=2.099～2.257,P均0.05);治疗4周末,研究组上述指标均低于治疗前(t=1.997～2.257,P0.05)。结论文拉法辛缓释胶囊联合MECT对中重度抑郁发作的效果较单用文拉法辛缓释胶囊的效果更好,联合组患者会出现短期、可逆的认知功能改变。

Effects of venlafaxine extended release capsules combined with MECT on efficacy and cognitive function in moderate and severe depression episode

Objective To compare the effects of venlafaxine extended release capsules combined with modified electroconvulsive therapy ( MECT) and venlafaxine sustained - release capsules alone on the efficacy and cognitive function of moderate to severe depressive episode. Methods 160 patients who met the diagnostic criteria of International Classification of Diseases, tenth edition ( ICD - 10) for depressive episode were enrolled in this study. According to the random number table, they were divided into the venlafaxine extended release capsules combined with MECT group ( the research group) and the venlafaxine extended release capsules alone ( the control group) with 80 subjects in each group. The initial dose of venlafaxine in both groups was 75 mg /d, and the dosage could be increased to 225 mg /d depending on the patient''s disease status and tolerance. At the same time, the research group received 8 times MECT in total. At the 1st week, they received MECT once a day for 5 consecutive treatments. At the 2nd week of treatment, patients received MECT once every other day for a total of 3 times. The study period was 4 weeks. The depressive symptoms were assessed with Hamilton Depression Scale - 17 item ( HAMD - 17) at the baseline and the 2nd, 4th week of treatment. The cognitive function was assessed with Wisconsin Card Sorting Test ( WCST) only in study group. Results At the 2nd, 4th week of treatment, HAMD - 17 scores of both groups were lower than those before treatment ( t = 2. 846 ~ 9. 803, P < 0. 01 ) . At the end of the 2nd week, HAMD - 17 score of the study group was lower than that of the control group ( t = 2. 070, P < 0. 05 ) . The total response number, completion classification, error response number, conceptualization, non - persistent error and learning to learn scores of WCST in the study group were higher at the end of the 2nd week than before treatment ( t = 2. 099 ~ 2. 257, P < 0. 05) and the 4th week of treatment ( t = 1. 997 ~ 2. 257, P < 0. 05) . Conclusion The effect of venlafaxine extended release capsules combined with MECT is better than that of venlafaxine extended release capsules alone on moderate to severe depressive episode. The short - term and reversible cognitive function changes are observed in patients in the combination group.