经颅直流电刺激联合伏硫西汀对快感缺失型抑郁症患者的疗效探究

朱春燕; 胡希文; 菊轩; 孙继军

doi:10.16766/j.cnki.issn.1674-4152.002627

经颅直流电刺激联合伏硫西汀对快感缺失型抑郁症患者的疗效探究

doi: 10.16766/j.cnki.issn.1674-4152.002627

1.
浙江大学医学院附属精神卫生中心，杭州市第七人民医院精神六科，浙江杭州 310013
2.
浙江大学医学院附属精神卫生中心，杭州市第七人民医院精神三科

基金项目:

浙江省医药卫生科技计划项目 2021KY914

浙江省医药卫生科技计划项目 2020KY747

详细信息

通讯作者:
孙继军, E-mail: sjjzcy113@126.com

中图分类号: R749.05 R454.1
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- 被引次数: 0
出版历程
- 收稿日期: 2022-01-12
- 网络出版日期: 2022-11-29

Effectiveness of Transcranial Direct Current Stimulation Therapy Combined with Vortioxetine for patients with anhedonia depression

1.
No.6 Department of Psychiatry, Hangzhou Seventh People's Hospital; Affiliated Mental Health Center of Zhejiang 310013, China

摘要

摘要: 目的探讨以左背外侧前额叶为刺激靶点的经颅直流电刺激治疗对快感缺失型抑郁症的疗效。方法选取2020年6月—2021年6月在杭州市第七人民医院就诊的抑郁症患者61例，采用随机数字表法分为真刺激组(30例)和伪刺激组(31例)，真刺激组进行2 mA的经颅直流电刺激(transcranial direct current stimulation, tDCS)治疗，伪刺激组进行参数设定一致的伪刺激治疗，所有患者同时接受药物伏硫西汀10 mg/d治疗，2组均治疗2周。于治疗前、治疗1周、治疗2周分别进行汉密尔顿抑郁量表(HAMD-17)、斯耐思-汉密尔顿快感量表(SHAPS)、中文版快感缺失量表(DARS)评估。结果治疗前，2组患者年龄、性别、受教育年限、总病程、发作次数比较差异无统计学意义(均P＞0.05)。治疗后，真刺激组患者SHAPS评分、HAMD-17评分均低于治疗前(均P < 0.05)，DARS评分高于治疗前(P < 0.05)。治疗2周后，真刺激组患者SHAPS评分[(17.71±3.11)分]低于伪刺激组[(19.45±3.42)分]，真刺激组患者HAMD-17评分[(16.70±5.36)分]低于伪刺激组[(20.22±4.84)分]，真刺激组患者DARS评分[(46.27±8.75)分]高于伪刺激组[(39.84±9.69)分]，差异均有统计学意义(均P < 0.05)。结论以左背外侧前额叶为刺激靶点的tDCS治疗可以有效治疗快感缺失型抑郁症。
- 抑郁症 /
- 快感缺失 /
- 经颅直流电刺激
Abstract: Objective To investigate the therapeutic effect of transcranial direct current stimulation (tDCS) therapy targeting left dorsolateral prefrontal lobe on major depressive disorder (MDD) patients with anhedonic features. Methods A total of 61 patients with depression treated in Hangzhou Seventh People's Hospital from June 2020 to June 2021 were selected and randomly assigned to real tDCS group (30 cases) and sham tDCS group (31 cases). The real tDCS group was treated with 2 mA tDCS, the sham tDCS group was treated with the same parameter settings. All patients were treated with vortioxetine at 10 mg/d at the same time, and both groups were treated for 2 weeks. The Hamilton Depression Scale (HAMD-17), Snaith-Hamilton Pleasure Scale (SHAPS), Dimensional Anhedonia Rating Scale (DARS) were evaluated at baseline, 1 week and 2 weeks after treatment, respectively. Results Before treatment, there were no significant differences in age, gender, years of education, total disease course and episodes of disease between 2 groups (all P>0.05). After treatment, SHAPS score and HAMD-17 score in the real tDCS group were lower than those before treatment (all P < 0.05), and the DARS score was higher than that before treatment (P < 0.05). After 2 weeks of treatment, the SHAPS score in the real tDCS group [(17.71±3.11) points] was lower than that in the sham tDCS group [(19.45±3.42) points], and the HAMD-17 score in the real tDCS group [(16.70±5.36) points] was also lower than that in the sham tDCS group [(20.22±4.84) points]. the DARS score in the real tDCS group [(46.27±8.75) points] was higher than that in the sham tDCS group [(39.84±9.69) points], and the difference was all statistically significant (all P < 0.05). Conclusion tDCS therapy targeting the left dorsolateral prefrontal cortex can effectively treat MDD patients with anhedonic features.
- Depressive disorder /
- Anhedonia /
- Transcranial direct current stimulation

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表 1 2组抑郁症患者临床基本特征比较

Table 1. Comparison of basic clinical features of two groups of patients with depression

组别	例数	性别(例)		年龄 (x±s，岁)	受教育年限 (x±s，年)	总病程 (x±s，月)	发作次数 (x±s，次)
组别	例数	男性	女性	年龄 (x±s，岁)	受教育年限 (x±s，年)	总病程 (x±s，月)	发作次数 (x±s，次)
真刺激组	30	18	12	27.13±6.92	13.17±4.14	7.46±3.67	2.30±0.91
伪刺激组	31	20	11	26.22±6.58	12.29±3.17	6.81±4.34	2.06±0.85
统计量		0.716^a		0.525^b	0.872^b	0.640^b	1.039^b
P值		0.795		0.602	0.387	0.525	0.303
注：^a为χ²值，^b为t值。

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表 2 2组抑郁症患者不同时间点SHAPS评分比较(x ±s，分)

Table 2. Comparison of SHAPS scores of two groups of depressed patients at different time points (x ±s, points)

组别	例数	治疗前	治疗1周	治疗2周	F值	P值
真刺激组	30	29.43±2.47	20.90±3.35^a	17.71±3.11^a	78.128	＜0.001
伪刺激组	31	29.39±2.75	24.42±3.16^a	19.45±3.42^a	7.328	0.001
t值		0.069	4.899	2.090
P值		0.945	＜0.001	0.041
注：与治疗前比较，^aP＜0.05。

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表 3 2组抑郁症患者不同时间点DARS评分比较(x ±s，分)

Table 3. Comparison of DARS scores of two groups of depressed patients at different time points (x ±s, points)

组别	例数	治疗前	治疗1周	治疗2周	F值	P值
真刺激组	30	25.73±6.14	36.50±8.97^a	46.27±8.75^a	10.317	＜0.001
伪刺激组	31	26.52±7.63	29.81±8.93^a	39.84±9.69^a	8.113	＜0.001
t值		0.440	2.919	2.716
P值		0.661	0.005	0.009
注：与治疗前比较，^aP＜0.05。

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表 4 2组抑郁症患者不同时间点HAMD-17评分比较(x ±s，分)

Table 4. Comparison of HAMD-17 scores between two groups of depressed patients at different time points (x ±s, points)

组别	例数	治疗前	治疗1周	治疗2周	F值	P值
真刺激组	30	31.23±6.89	21.63±5.53^a	16.70±5.36^a	93.897	＜0.001
伪刺激组	31	32.35±5.55	24.65±4.48^a	20.22±4.84^a	63.311	＜0.001
t值		0.701	2.342	2.698
P值		0.486	0.023	0.009
注：与治疗前比较，^aP＜0.05。

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参考文献(30)

[1]	MAJ M, STEIN D J, PARKER G, et al. The clinical characterization of the adult patient with depression aimed at personalization of management[J]. World Psychiatry, 2020, 19(3): 269-293. doi: 10.1002/wps.20771
[2]	DE FRUYT J, SABBE B, DEMYTTENAERE K. Anhedonia in depressive disorder: A narrative review[J]. Psychopathology, 2020, 53(5-6): 274-281. doi: 10.1159/000508773
[3]	MALHI G S, MANN J J. Depression[J]. Lancet, 2018, 392(10161): 2299-2312. doi: 10.1016/S0140-6736(18)31948-2
[4]	GONDA X, SHARMA S R, TARAZI F I. Vortioxetine: A novel antidepressant for the treatment of major depressive disorder[J]. Expert Opin Drug Discov, 2019, 14(1): 81-89. doi: 10.1080/17460441.2019.1546691
[5]	汪作为, 彭代辉, 刘晓华, 等. 忧郁/快感缺失型抑郁症临床评估与诊治指导建议[J]. 临床精神医学杂志, 2021, 31(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJS202101001.htm WANG Z W, PENG D H, LIU X H, et al. Recommendations of clinical evaluation, diagnosis and treatment for patients of depression with melancholic or anhedonic features[J]. Journal of Clinical Psychiatry, 2021, 31(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJS202101001.htm
[6]	SAMPAIO-JUNIOR B, TORTELLA G, BORRIONE L, et al. Efficacy and safety of transcranial direct current stimulation as an add-on treatment for bipolar depression: A randomized clinical trial[J]. JAMA Psychiatry, 2018, 75(2): 158-166. doi: 10.1001/jamapsychiatry.2017.4040
[7]	CSIFCSÁK G, BOAYUE N M, PUONTI O, et al. Effects of transcranial direct current stimulation for treating depression: A modeling study[J]. J Affect Disord, 2018, 234: 164-173. doi: 10.1016/j.jad.2018.02.077
[8]	美国精神医学学会. 精神障碍诊断与统计手册(第5版)(DSM-5)[M]. 张道龙, 等, 译. 北京: 北京大学出版社, 2016: 154-155. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th edition)[M]. ZHANG D L, et al, tranlation. Beijing: Peking University Press, 2016: 154-155.
[9]	张作记. 行为医学量表手册[M]. 北京: 中华医学电子音像出版社, 2005: 214-215. ZHANG Z J. Manual of Behavioral Medicine Scales[M]. Beijing: China Medical Electronic Audiovisual Publishing House, 2005: 214-215.
[10]	贾海玲, 王丽, 安静, 等. 快感缺失量表中文版在中国抑郁症患者中的信效度研究[J]. 中华精神科杂志, 2020, 53(3): 216-220. JIA H L, WANG L, AN J, et al. Reliability and validity of the chinese version of dimensional anhedonia rating scale of depression in China[J]. Chinese Journal of Psychiatry, 2020, 53(3): 216-220.
[11]	胡旭强, 钱敏才, 林敏, 等. 斯奈思-汉密尔顿快感量表中文版测评抑郁症患者的效度和信度[J]. 中国心理卫生杂志, 2017, 31(8): 625-629. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201708009.htm HU X Q, QIAN M C, LIN M, et al. Validity and reliability of the Chinese version of Snaith-Hamilton Pleasure Scale (SHAPS) in assessment of patients with depression[J]. Chinese Mental Health Journal, 2017, 31(8): 625-629. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201708009.htm
[12]	WHO ICD-10精神与行为障碍分类[M]. 范肖冬, 译. 北京: 人民卫生出版社, 1993: 97.
[13]	ZIMMERMAN M, BALLING C, CHELMINSKI I, et al. Understanding the severity of depression: Which symptoms of depression are the best indicators of depression severity?[J]. Compr Psychiatry, 2018, 87: 84-88. doi: 10.1016/j.comppsych.2018.09.006
[14]	VINCKIER F, GOURION D, MOUCHABAC S. Anhedonia predicts poor psychosocial functioning: Results from a large cohort of patients treated for major depressive disorder by general practitioners[J]. Eur Psychiatry, 2017, 44: 1-8. doi: 10.1016/j.eurpsy.2017.02.485
[15]	IMAI H, NOMA H, FURUKAWA T A, et al. Melancholic features (DSM-IV) predict but do not moderate response to antidepressants in major depression: An individual participant data meta-analysis of 1219 patients[J]. Eur Arch Psychiatry Clin Neurosci, 2021, 271(3): 521-526. doi: 10.1007/s00406-020-01173-4
[16]	VALERIO M P, SZMULEWICZ A G, MARTINO D J. A quantitative review on outcome-to-antidepressants in melancholic unipolar depression[J]. Psychiatry Res, 2018, 265: 100-110. doi: 10.1016/j.psychres.2018.03.088
[17]	CAO B, ZHU J, ZUCKERMAN H, et al. Pharmacological interventions targeting anhedonia in patients with major depressive disorder: A systematic review[J]. Prog Neuropsychopharmacol Biol Psychiatry, 2019, 92: 109-117. doi: 10.1016/j.pnpbp.2019.01.002
[18]	SABELLA D. Antidepressant medications[J]. Am J Nurs, 2018, 118(9): 52-59. doi: 10.1097/01.NAJ.0000544978.56301.f6
[19]	ALBREIKI M, ALMAQBALI M, ALRISI K, et al. Prevalence of antidepressant-induced sexual dysfunction among psychiatric outpatients attending a tertiary care hospital[J]. Neurosciences (Riyadh), 2020, 25(1): 55-60. doi: 10.17712/nsj.2020.1.20190058
[20]	LIN Y Y, CHANG C C, HUANG C C Y, et al. Efficacy and neurophysiological predictors of treatment response of adjunct bifrontal transcranial direct current stimulation (tDCS) in treating unipolar and bipolar depression[J]. J Affect Disord, 2021, 280(Pt A): 295-304.
[21]	BRUNONI A R, MOFFA A H, SAMPAIO-JUNIOR B, et al. Trial of electrical direct-current therapy versus escitalopram for depression[J]. N Engl J Med, 2017, 376(26): 2523-2533. doi: 10.1056/NEJMoa1612999
[22]	刘文娟, 宋明芬, 王伟, 等. 重复经颅磁刺激联合舍曲林对产后抑郁症患者抑郁症状及外周血相关miR表达的影响[J]. 中华全科医学, 2021, 19(3): 441-445. doi: 10.16766/j.cnki.issn.1674-4152.001831 LIU W J, SONG M F, WANG W, et al. Effects of repetitive transcranial magnetic stimulation combined with sertraline on depressive symptoms and related miR-expression in peripheral blood of patients with postpartum depression[J]. Chinese Journal of General Practice, 2021, 19(3): 441-445. doi: 10.16766/j.cnki.issn.1674-4152.001831
[23]	RUSSO G B, TIRRELL E, BUSCH A, et al. Behavioral activation therapy during transcranial magnetic stimulation for major depressive disorder[J]. J Affect Disord, 2018, 236: 101-104. doi: 10.1016/j.jad.2018.04.108
[24]	HÖFLICH A, MICHENTHALER P, KASPER S, et al. Circuit mechanisms of reward, anhedonia, and depression[J]. Int J Neuropsychopharmacol, 2019, 22(2): 105-118. doi: 10.1093/ijnp/pyy081
[25]	BAUNE B T, BRIGNONE M, LARSEN K G. A Network meta-analysis comparing effects of various antidepressant classes on the digit symbol substitution test (DSST) as a measure of cognitive dysfunction in patients with major depressive disorder[J]. Int J Neuropsychopharmacol, 2018, 21(2): 97-107. doi: 10.1093/ijnp/pyx070
[26]	ALONZO A, FONG J, BALL N, et al. Pilot trial of home-administered transcranial direct current stimulation for the treatment of depression[J]. J Affect Disord, 2019, 252: 475-483. doi: 10.1016/j.jad.2019.04.041
[27]	MUTZ J, VIPULANANTHAN V, CARTER B, et al. Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: Systematic review and network meta-analysis[J]. BMJ, 2019, 364: 1079.
[28]	KENNEY-JUNG D L, BLACKER C J, CAMSARI D D, et al. Transcranial direct current stimulation: Mechanisms and psychiatric applications[J]. Child Adolesc Psychiatr Clin N Am, 2019, 28(1): 53-60.
[29]	OPIE G M, SEMMLER J G. Preferential activation of unique motor cortical networks with transcranial magnetic stimulation: A review of the physiological, functional, and clinical evidence[J]. Neuromodulation, 2021, 24(5): 813-828.
[30]	PAN Z, ROSENBLAT J D, SWARDFAGER W, et al. Role of proinflammatory cytokines in dopaminergic system disturbances, implications for anhedonic features of MDD[J]. Curr Pharm Des, 2017, 23(14): 2065-2072.