重复经颅磁刺激联合帕罗西汀治疗重性抑郁障碍

doi:10.3969/j.issn.1006-7795.2014.02.011

首都医科大学学报 ›› 2014, Vol. 35 ›› Issue (2): 194-199.doi: 10.3969/j.issn.1006-7795.2014.02.011

重复经颅磁刺激联合帕罗西汀治疗重性抑郁障碍

房萌¹, 任艳萍², 刘辉¹, 周方¹, 王刚^2,3

1. 首都医科大学附属北京安定医院三病区, 北京 100088;
2. 首都医科大学附属北京安定医院, 北京 100088;
3. 北京脑重大疾病研究院抑郁症研究所, 北京 100088

收稿日期:2014-02-18 出版日期:2014-04-21 发布日期:2014-04-16
基金资助:
十一五国家科技支撑计划（2007BAI17B05）。

Repetitive transcranial magnetic stimulation in combination with paroxetine for major depressive disorder

Fang Meng¹, Ren Yanping², Liu Hui¹, Zhou Fang¹, Wang Gang^2,3

1. 3rd Ward of Beijing Anding Hospital, Capital Medical University, Beijing 100088, China;
2. Beijing Anding Hospital, Capital Medical University, Beijing 100088, China;
3. Center of Depression, Beijing Institute for Brain Disorders, Beijing 100088, China

Received:2014-02-18 Online:2014-04-21 Published:2014-04-16
Contact: 王刚 E-mail:gangwangdoc@gmail.com
Supported by:
This study was supported by National Science and Technology Support Program in 11th Five Year Plan of China(2007BAI17B05).

摘要/Abstract

摘要：

目的探讨重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）联合帕罗西汀对重性抑郁障碍（major depressive disorder，MDD）的疗效。方法本研究是一项为期6周的随机、双盲、伪刺激对照临床试验。48例MDD患者采用数字表法随机分为2组接受rTMS真（real）或伪（sham）刺激治疗2周，基线起同时合并固定剂量的帕罗西汀（20 mg/d），rTMS治疗结束后随访至6周末，随访期间帕罗西汀治疗剂量保持不变。设置7个访视点进行疗效评定和不良事件记录。结果研究结束时，两组患者的蒙哥马利抑郁量表、汉密尔顿抑郁量表17 项、汉密尔顿焦虑量表评分较基线均显著降低，但两组对比总体疗效相当。Real组平均起效时间比Sham组早3天，但差异不具有统计学意义。符合方案人群分析显示Real组对汉密尔顿抑郁量表"焦虑/躯体化"因子分的改善，在第10、14、28天显著优于Sham组；对汉密尔顿焦虑量表评分的改善在第10天显著优于Sham组。2组患者的不良事件发生率差异无统计学意义。结论 rTMS联合帕罗西汀是一种较好的抑郁症治疗方法，显示出较快起效的趋势，rTMS对焦虑症状、躯体化症状可能具有较快的改善作用。

关键词: 重复经颅磁刺激, 重性抑郁障碍, 起效时间

Abstract:

Objective To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS) in combination with paroxetine for major depressive disorder. Methods In a 6-week, randomized, double-blind, sham-controlled trial, 48 patients with major depressive disorder were randomly assigned to receive real or sham rTMS for 2 weeks. During the 6 weeks, paroxetine was used at a fixed dose of 20 mg per day for all participants. Seven sites were set to conduct assessment of efficacy and adverse events in this study. Results The Montgomery-Asberg Depression Rating(MADRS), the 17-item Hamilton Depression Rating Scale(HAMD-17) and Hamilton Anxiety Rating Scale(HAMA) scores significantly decreased from baseline to the endpoint in both groups. No meaningful difference was observed between the two groups in general clinical effect. The mean time-to-onset was earlier by 3 days in Real group, but the difference was not significant. In the Real group, the scores of HAMD anxiety/somatic symptom factor significantly decreased on day10, 14 and 28; the scores of HAMA significantly decreased on day 10. The incidence of adverse events in both groups had no significant difference. Conclusion The combination of rTMS and paroxetine was effective and safe in treatment of MDD. The tendency of fast onset of effect was observed in the comprehensive intervention, which probably is beneficial to the patients with anxiety and somatic symptoms.

Key words: repetitive transcranial magnetic stimulation, major depressive disorder, time-to-onset

中图分类号:

R749.4

房萌, 任艳萍, 刘辉, 周方, 王刚. 重复经颅磁刺激联合帕罗西汀治疗重性抑郁障碍[J]. 首都医科大学学报, 2014, 35(2): 194-199.

Fang Meng, Ren Yanping, Liu Hui, Zhou Fang, Wang Gang. Repetitive transcranial magnetic stimulation in combination with paroxetine for major depressive disorder[J]. Journal of Capital Medical University, 2014, 35(2): 194-199.

参考文献

[1] Stahl S M, Nierenberg A A, Gorman J M. Evidence of early onset of antidepressant effect in randomized controlled trials[J]. J Clin Psychiatry, 2001, 62(suppl 4):17-23.

[2] Entsuah A R, Huang H, Thase M E. Response and remission rates in different subpopulations with major depressive disorder administered venlafaxine, selective serotonin reuptake inhibitors, or placebo[J]. J Clin Psychiatry, 2001, 62(11):869-877.

[3] Shajahan P M, Glabus M F, Steele J D, et al. Left dorso-lateral repetitive transcranial magnetic stimulation affects cortical excitability and functional connectivity, but does not impair cognition in major depression[J]. Prog Neuropsychopharmacol Biol Psychiatry, 2002, 26(5):945-954.

[4] Fregni F, Santos C M, Myzckowski M L, et al. Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson's disease[J]. J Neurol Neurosurg Psychiatry, 2004, 75(8):1171-1174.

[5] Janicak P G, Dowd S M, Martis B, et al. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: preliminary results of a randomized trial[J]. Biol Psychiatry, 2002, 51(8):659-667.

[6] Loo C K, Taylor J L, Gandevia S C, et al. Transcranial magnetic stimulation(TMS) in controlled treatment studies:are some "sham"forms active?[J]. Biol Psychiatry, 2000, 47(4):325-331.

[7] Rossini D, Magri L, Lucca A, et al. Does rTMS hasten the response to escitalopram, sertraline, or venlafaxine in patients with major depressive disorder? A double-blind, randomized, sham-controlled trial[J]. J Clin Psychiatry, 2005, 66(12):1569-1575.

[8] Perez V, Gilaberte I, Faries D, et al. Randomised, double-blind, placebo-controlled trial of pindolol in combination with fluoxetine antidepressant treatmen[J]. Lanct, 1997, 349(9065):1594-1597.

[9] Montgomery S A, Bech P, Blier P, et al. Selecting Methodologies for the evaluation of differences in time to response between antidepressants[J]. J Clin Psychiatry, 2002, 63(8):694-699.

[10] 王卓, 王化宁, 陈云春, 等.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[J].临床精神医学杂志, 2012, 22(3):188-190.

[11] Huang M L, Luo B Y, Hu J B, et al. Repetitive transcranial magnetic stimulation in combination with citalopram in young patients with first-episode major depressive disorder:a double-blind, randomized, sham-controlled trial[J]. Aust NZJ Psychiatry, 2012, 46(3):257-264.

[12] 王文菁, 钟天平.重复经颅磁刺激联合5-羟色胺再摄取抑制剂治疗抑郁症的早期疗效[J].广东医学, 2007, 28(12):1993-1994.

[13] Rumi D O, Gattaz W F, Rigonatti S P, et al. Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind, placebo-controlled study[J]. Biol Psychiatry, 2005, 57(2):162-166.

[14] Mayberg H S, Brannan S K, Mahurin R K. Cingulate function in depression: a potential predictor of treatment response[J]. Neuroreport, 1997, 8(4):1057-1061.

[15] 曹杨, 刘长辉, 吴枫, 等.首发未用药重性抑郁障碍患者生活事件刺激量的研究[J].中国医科大学学报, 2012, 41(3):278-281.

[16] Wassermann E M, Cohen L G, Flitman S S, et al. Seizures in healthy people with repeated "safe" trains of transcranial magnetic stimuli[J]. Lancet, 1996, 347(9004):825-836.

[17] 常凤友.难治性抑郁症的增效治疗[J].中国煤炭工业医学杂志, 2011, 14(11):1730.

[18] 付华斌, 陈峰, 罗克勇, 等.难治性抑郁症的研究进展[J].解放军医药杂志, 2011, 23(3):67-69.

重复经颅磁刺激联合帕罗西汀治疗重性抑郁障碍

Repetitive transcranial magnetic stimulation in combination with paroxetine for major depressive disorder

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 4

编辑推荐

Metrics

本文评价

[1]	孙丛丛, 吴涵, 周丹娜, 姜玮, 王雯, 杨春林, 马辛, 任艳萍. 脑源性神经营养因子对经颅磁刺激治疗难治性抑郁症的疗效预测作用[J]. 首都医科大学学报, 2022, 43(2): 227-232.
[2]	张颖彬, 莫林宏, 聂忆秋, 刘爱贤. 近红外脑功能成像在重复经颅磁刺激治疗脑卒中后轻度认知功能障碍的应用[J]. 首都医科大学学报, 2020, 41(6): 965-969.
[3]	孙丛丛, 周丹娜, 宁芳平, 马良, 闫丽琼, 任艳萍, 马辛. 重复经颅磁刺激治疗难治性精神分裂症的增效作用研究[J]. 首都医科大学学报, 2018, 39(5): 641-645.
[4]	李峰, 薄奇静, 赵燕, 刘辉, 王传跃. 重性抑郁障碍病人生活质量及其影响因素[J]. 首都医科大学学报, 2017, 38(2): 186-191.