|
| 右侧低频重复经颅磁刺激对老年抑郁症共病焦虑疗效的临床随机对照研究 |
| Clinical randomized controlled study of low-frequency repetitive transcranial magnetic stimulation on comorbid anxiety in elderly depression on the right side |
| 投稿时间：2024-11-20 修订日期：2024-11-20 |
| DOI： |
| 中文关键词: 老年抑郁症 焦虑 低频重复经颅磁刺激 治疗 随机对照试验 |
| 英文关键词: Geriatric depression anxiety low-frequency repetitive transcranial magnetic stimulation treatment randomized controlled trial |
| 基金项目: |
|
| 摘要点击次数: 34 |
| 全文下载次数: 0 |
| 中文摘要: |
| 背景 老年抑郁症共病焦虑在临床诊疗中较常见，单一的抗抑郁药物治疗效果不佳，治疗反应时间较长，且容易复发。而右侧低频重复经颅磁刺激治疗在改善抑郁症方面安全有效，患者依从性好，但鲜有研究关注其在老年抑郁症共病焦虑患者疗效。目的 探讨右侧低频经颅磁刺激治疗对老年抑郁症共病焦虑患者的疗效及安全性。方法 选取2021年01月至2021年06月在华中科技大学同济医学院附属梨园医院精神科住院的老年抑郁症共病焦虑的患者72例，采用随机数字表法将患者分为低频组（37例）和对照组(35例)，两组均接受抗抑郁治疗，低频组给予1.0Hz的rTMS治疗，刺激部位为右侧背外侧前额叶皮质区，每日治疗1次，每次 20min，每周5次，治疗4周，共20次，对照组给予相同时间和频次的伪刺激治疗。在治疗前、治疗后1、2、3、4、6、8周末，采用汉密尔顿抑郁量表24项（HAMD-24）、汉密尔顿焦虑量表14项（HAMA-14）评估两组患者焦虑抑郁情况及有效率，记录两组患者不良反应。采用重复测量方差分析对不同时间点两组患者焦虑抑郁评分进行比较。结果 两组患者HAMD-24评分、HAMA-14评分的时间主效应、组间主效应、时间*组间互交效应具有统计学意义（p＜0.05）。进一步进行简单效应分析结果显示，治疗1、2、3、4、6、8周时2组HAMD-24评分均低于治疗前（p＜0.001）。在治疗前、治疗1、2、3、4周时2组HAMD评分差异无统计学意义（p＞0.05），在治疗6周时低频组HAMD-24评分低于对照组（p＜0.001），在治疗8周时低频组HAMD-24评分低于对照组（p＜0.05）（表2）。治疗1、2、3、4、6、8周时两组HAMA-14评分均低于治疗前（p＜0.001）。在治疗1、2周时两组HAMA-14评分差异有统计学意义（p＜0.05），在治疗3、4、5、6、8周时两组HAMA-14评分差异有显著统计学意义（p＜0.001）。治疗4周后两组焦虑抑郁症状总有效率差异有统计学意义（p＜0.05），治疗6周后两组焦虑抑郁症状的显效率差异具有统计学意义（p＜0.05），治疗8周后两组焦虑抑郁症状的显效率差异无统计学意义（p＞0.05）。结论 抗抑郁药联合右侧低频重复经颅磁刺激治疗可有效缓解老年抑郁症共病焦虑患者焦虑抑郁症状，且优于单纯抗抑郁药物治疗。 |
| 英文摘要: |
| Background Comorbid anxiety in geriatric depression is common in clinical practice. Monotherapy with antidepressants yields poor treatment outcomes, prolonged response times, and a high risk of relapse. Conversely, low-frequency repetitive transcranial magnetic stimulation of the right dorsolateral prefrontal cortex is safe and effective in improving depression with good patient compliance. However, there is limited research on its efficacy in geriatric patients with comorbid anxiety. Objective Exploring the efficacy and safety of right-sided low-frequency transcranial magnetic stimulation in the treatment of geriatric patients with comorbid depression and anxiety. Methods We selected 72 elderly patients with comorbid depression and anxiety who were hospitalized in the Department of Psychiatry at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2021 to June 2021. The patients were randomly divided into a low-frequency group (37 cases) and a control group (35 cases) using a random number table. Both groups received antidepressant treatment. The low-frequency group received 1.0Hz rTMS treatment, with stimulation targeting the right dorsolateral prefrontal cortex. The treatment was administered once daily for 20 minutes, five times a week, for a total of 4 weeks (20 sessions). The control group received sham stimulation treatment with the same duration and frequency. The Hamilton Depression Scale 24-item (HAMD-24) and Hamilton Anxiety Scale 14-item (HAMA-14) were used to assess the anxiety and depression levels and treatment efficacy of the two groups before treatment, and at 1, 2, 3, 4, 6, and 8 weeks after treatment. Adverse reactions in the two groups were recorded. Repeated measures analysis of variance was used to compare anxiety and depression scores at different time points between the two groups. Conclusion The combination of antidepressants with right-sided low-frequency repetitive transcranial magnetic stimulation (rTMS) treatment can effectively alleviate anxiety and depression symptoms in elderly patients with comorbid depression and anxiety, and is superior to treatment with antidepressants alone. |
|
View Fulltext
查看/发表评论 下载PDF阅读器 |
| 关闭 |