舍曲林合并无抽搐电休克治疗老年抑郁症的临床研究

目的 了解舍曲林合并无抽搐电休克（MECT）治疗对老年抑郁症患者的疗效与不良反应.方法 对83例符合老年抑郁症的患者按随机数字表法分为研究组41例和对照组42例,研究组给予舍曲林合并MECT治疗,对照组单用舍曲林治疗,观察8周.分别于治疗前、治疗后第1、2、4和8周末时采用汉密尔顿抑郁量表（HAMD17）评定疗效,不良反应症状量表（TESS）评定不良反应.研究组治疗前后采用临床记忆量表甲套评定认知功能.结果 研究组脱落7例,对照组脱落5例.研究组治疗后第1、2、4、8周末时的HAMD17总分较治疗前显著下降（P＜0.05）,对照组治疗第2、4、8周末HAMD17总分较治疗前下降（P＜0.05）.两组间治疗后第2周末时HAMD17总分比较差异有统计学意义（P＜0.05）.研究组治疗后第1个24h临床记忆量表甲套中指向记忆、图像自由回忆项目分较治疗前下降（均P＜0.05）,治疗第2周末联想学习、无意义图形再认项目分及记忆商值较治疗前升高（均P＜0.05）,治疗第8周末除图像自由回忆项目外,其他项目分及记忆商值较治疗前升高（P＜0.05或0.01）.研究组HAMD减分率（76.23＆#177;21.41）％,临床总有效率85.29％,临床痊愈率47.06％;对照组HAMD减分率（51.26＆#177;18.13）％,临床总有效率64.86％,临床痊愈率21.62％,两组间差异均有统计学意义（均P＜0.05）.两组患者各时点的TESS评分比较差异无统计学意义（P＞0.05）.结论 舍曲林合并MECT治疗能提高老年抑郁症的疗效,无严重不良反应.

Modified electroconvulsive therapy combined with sertraline in treatment of elderly patients with major depression

Objective To evaluate the efficacy and safety of modified electroconvulsive therapy （MECT） combined with sertraline in treatment of elderly patients with major depression. Methods Eighty three elderly patients with major depression were randomly assigned to receive MECT combined with sertraline （trial group, n=41） or sertraline （control group, n=42） for 8 weeks. The Hamilton Rating Scale for Depression （HAMD） and Treatment Emergent Symptom Scale （TESS） were used to measure therapeutic efficacy and side effects. The Clinical Memory Scale was used to evaluate cognitive functions prior to and post the treatment. Results HAMD score decreased 1 week after treatment in trial group, which was not significantly different to that of control group, while HAMD score in trial group was decreased more markedly than that of control group at the end of week 2. The directing memory and image free recollection of Clinical Memory Scale in trial group were decrease 24h after treatment （P〈 0.05）, the scale scores and memory scores were increased significantly at the end of weeks 8 （P〈0.05 or P〈0.01）. There were significant differences in the decreasing rate of HAMD score （76.23 ±21.41% vs 51.26 ±18.13%, P〈0.05）, the response rate （85.29% vs 64.86%, P〈0.05） and the recovery rate （47.06% vs 21.62%, P〈0.05） between two groups. There was no significant difference in TESS scores between two groups （P 〉0.05）. Conclusion MECT combined with sertraline can improve efficacy for elderly patients with major depression and not increase the side effects.