摘要/Abstract
摘要： 目的 ·探讨高强度高频率重复经颅磁刺激（ repetitive transcranial magnetic stimulation，rTMS）治疗抑郁症自杀意念的效果及安全性，以及对于自杀意念症状的快速缓解程度。方法 ·共有 14例伴有严重自杀意念的门诊抑郁症患者入组，接受 5 Hz高强度左侧背外侧前额叶 rTMS治疗，每日重复 3～ 4次，连续治疗 3 d，共计 10次 20 000个刺激脉冲； rTMS治疗期间抗抑郁药剂量不变。分别在基线入组时以及入组后第 4日、第 2周、第 4周进行自杀意念量表（ Scale for Suicidal Ideation，SSI）、汉密尔顿抑郁量表 17项 (Hamilton Depression Scale-17，HAMD17)、临床疗效总评量表严重度分量表 (Clinical Global Impression-Severity of Illness，CGI-SI)评定。结果 · 5 Hz高频 rTMS治疗安全，患者耐受性好。 SSI总分在 rTMS治疗结束后各随访时点均显著下降（ F15.788，P0.000），以 rTMS治疗结束的次日（第 4日）SSI分值下降最显著，其抗自杀意念效果可持续至入组 4周以后。自杀意念下降程度与 HAMD 17分值下降存在相关性（ t5.658，P0.000），与 CGI-SI分值不存在相关性（ t-1.058，P0.295）。高强度高频率 rTMS治疗对抑郁症状改善显著，入组 4周后总显效率达 78.57%。结论 ·高强度高频率 rTMS治疗能快速减少抑郁症患者自杀意念，安全性好；自杀意念缓解程度与 rTMS抗抑郁疗效相关，且其疗效可以维持。
关键词: 重复经颅磁刺激, 抑郁症, 自杀意念, 自杀
Abstract:
Objective · To investigate the effects and safety of accelerated repetitive transcranial magnetic stimulation (rTMS) on suicide ideation in depressive patients and to examine whether intensive rTMS has a rapid remission of suicidal ideations or not. Methods · A total of 14 depression out patients with severe suicidal ideations were enrolled in the study. All the participants were treated with rTMS (5 Hz) on the left dorsolateral prefrontal cortex. rTMS was delivered 3-4 times daily for 3 d (total 10 sessions, 20 000 stimuli). The participants were taking antidepressants at a fixed effective dose during rTMS treatment. Scale for Suicidal Ideation (SSI), Hamilton Depression Scale-17 (HAMD17) and Clinical Global Impression-Severity of Illness (CGI-SI) were assessed at baseline and 4 d, 2 weeks and 4 weeks after baseline. Results · rTMS of 5 Hz was safe and well-tolerated. The SSI scores decreased significantly at all follow-up timepoints after rTMS treatment (F15.788, P0.000), and the SSI score decreased the most significantly the day after the end of rTMS therapy. The effect of anti-suicide ideation could be maintained after 4 weeks. There was a significant correlation between the degree of decrease of suicidal ideation and the decrease of HAMD17 score (t5.658, P0.000), but not related with CGI-SI (t-1.058, P0.295). accelerated rTMS treatment improved depressive symptoms significantly, and the total effective rate reached 78.57% after 4 weeks the baseline. Conclusion · accelerated rTMS treatment may have the potential to quickly reduce suicide ideation in depressive patients, with good safety. The degree of decrease in suicide ideation is related to the antidepressant effect of rTMS, and its efficacy can be maintained.
Key words: repetitive transcranial magnetic stimulation (rTMS), depression, suicidal ideation, suicide
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