重复经颅磁刺激对老年抑郁症患者临床症状及自杀意念的疗效

目的：探讨重复经颅磁刺激对老年抑郁症患者临床症状及自杀意念的疗效。方法将178例老年抑郁症有自杀意念的患者随机分为两组，研究组80例，对照组98例，两组均给予常规药物治疗，研究组在常规药物治疗的基础上联合重复经颅磁刺激治疗，每周5次，2周为1个疗程，治疗4周。分别于治疗前、治疗2周、治疗4周后采用汉密尔顿抑郁量表（HAMD）和自杀意念自评量表（SIOSS）对治疗效果进行评分。治疗2周后减分率≥20%为显效，治疗4周后减分率≥25%为有效。结果（1）两组患者在年龄、性别、民族、职业、婚姻状况、受教育程度等方面比较均无统计学差异（P>0.05）；（2）两组患者治疗前HAMD评分及SIOSS评分无统计学差异（P>0.05），治疗后两组的评分均有不同程度的降低，但研究组更显著（P<0.05）；（3）研究组在治疗2周后显效率明显高于对照组，两组比较有显著的统计学意义（52.5%vs 28.6%；χ2=10.569，P<0.01）；研究组治疗4周后的有效率明显高于对照组，两组比较有显著的统计学意义（77.5%vs 53.1%；χ2=15.470，P<0.05）。结论重复经颅磁刺激能缩短起效时间，改善老年抑郁症患者的临床症状，首先改善患者睡眠质量，随治疗时间的延长，认识障碍、躯体化症状、迟缓等状况也明显改善，并且能减轻老年抑郁症患者的自杀意念，降低自杀风险。

Efficacy of repetitive transcranial magnetic stimulation for alleviating clinical symptoms and suicidal ideation in elderly depressive patients:a randomized controlled trial

Objective To assess the efficacy of repetitive transcranial magnetic stimulation (rTMS) for alleviating the clinical symptoms and suicidal ideation in elderly patients with depression. Methods A total of 178 elderly depressive patients with suicidal ideation were randomized into rTMS treatment group (n=80) and control group (n=98) and treated with rTMS or sham rTMS treatment for 4 weeks in addition to conventional therapy with medications. The 24-item Hamilton Depression Scales (HAMD) and Self-rating Idea of Suicide Scale (SIOSS) were used to assess the severity of depression and the risk of suicide at the baseline and after 2 and 4 weeks of treatment. The treatment response was defined as a 25%reduction in HAMD scores from baseline, and an early improvement as 20% reduction in HAMD scores after 2 weeks of treatment. Results The two groups of patients were comparable for baseline socio-demographic characteristics and baseline SIOSS and HAMD scores (P>0.05). After 2 and 4 weeks of treatment, both SIOSS and HAMD scores were improved in the two groups, but the patients in rTMS group showed a significantly faster score reduction. A significantly higher rate of early improvement at 2 weeks (52.5%vs 28.6%;χ2=10.569, P<0.01) and a higher response rate at 4 weeks (77.5%vs 53.1%;χ2=15.470, P<0.05) were observed in rTMS group. Conclusions rTMS combined with medications can effectively improve sleep quality, cognitive impairment and somatization symptom and reduce suicidal ideation in elderly patients with depression.