A randomized controlled study of magnetic seizure therapy and modified electroconvulsive therapy in the treatment of major depressive episodes
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目的 比较磁休克治疗(magnetic seizure therapy,MST)与改良电休克治疗(modified electro-convulsive therapy,MECT)重度抑郁发作(major depressive episode,MDE)的临床疗效及对认知功能的影响.方法 选取2019年1月1日至2021年12月31日上海交通大学医学院附属精神卫生中心符合美国精神障碍诊断与统计手册第5版(Diagnostic and Statistical Manual of Mental Disorders,fifth edition.DSM-5)中MDE(抑郁症或双相障碍)诊断的住院患者40例,采用随机数字表法随机分为MECT组(n=20)和MST组(n=20).2组均在接受选择性5-羟色胺再摄取抑制剂(selective serotonin reuptake inhibitors.SSRIs)治疗的基础上使用MECT或MST,每周3次,共治疗4周.2组治疗前和治疗后分别进行17项汉密尔顿抑郁量表(17-items Hamilton Depression Rating Scale,HAMD17)和可重复神经心理状态测验(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)评估,治疗前和治疗后比较采用两因素重复测量方差分析.以HAMD17减分率及有效率为主要评估指标,RBANS总分及因子分为次要评估指标,2组HAMD17减分率比较采用t检验,治疗有效率比较采用校正卡方检验或Fisher精确概率法.结果 2组治疗前HAMD17评分及RBANS评分差异均无统计学意义(t=0.29,P=0.773;t=0.67,P=0.509);MECT 组治疗有效率 90％(18/20),HAMD17 减分率平均为 67.9％;MST组治疗有效率75％(15/20),HAMD17减分率平均为60.9％,2组HAMD17减分率及有效率差异无统计学意义(t=0.69,P=0.493;x2=0.16,P=0.693).MECT组治疗后RBANS认知测验总分及因子分(即刻记忆评分、言语功能评分、注意评分、延时记忆评分)均小于治疗前,差异均有统计学意义(F=19.29、6.22、9.13、5.23、35.90,均P＜0.05);而MST组治疗前与治疗后的RBANS认知测验总分及因子分差异均无统计学意义(F=0.49、2.25、1.22、0.23、0.02,均P＞0.05).结论 MST与MECT治疗MDE患者疗效相当,MST相较于MECT对认知功能影响较小.
Objective To compare the clinical efficacy and effects on cognitive function of magnetic seizure therapy(MST)and modified electroconvulsive therapy(MECT)in the treatment of major depressive episode(MDE).Methods From January 1,2019 to December 31,2021,40 patients who met the MDE diagnostic criteria in the fifth edition of the Diagnostic Statistical Manual of Mental Disorders(DSM-5)were selected in Shanghai Mental Health Center.Participants were randomly assigned to MECT therapy group(20 patients)and MST therapy group(20 patients)using the random number table method.Both groups received MECT or MST while using serotonin reuptake inhibitors(SSRIs),3 times a week for 4 weeks.The 17-items Hamilton Depression Rating Scale(HAMD17)and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)were performed before and after treatment.HAMD17 reduction rate and effective rate were the main assessment indicators,while RBANS total score and factor scores were considered as the secondary assessment indicators.T-test was used to compare the reduction rate of HAMD17 between the two groups,and corrected Chi-square test or Fisher's exact probability method was used to compare the effective rate of treatment between the two groups.HAMD17 scores and RBANS scores before and after treatment were compared using two-factor repeated measure ANOVA.Results There were no significant differences in baseline HAMD17 scores and RBANS scores between 2 groups(t=0.29,P=0.773;t=0.67,P=0.509).The treatment effective rate in the MECT group was 90％(18/20),and the average reduction rate of HAMD17 was 67.9％.Meanwhile,the effective rate of MST group was 75％(15/20),and the average reduction rate of HAMD17 was 60.9％.There was no significant difference in the reduction rate and effective rate of HAMD17 between the two groups(t=0.69,P=0.493;x2=0.16,P=0.693).The total scores and factor scores of RBANS after treatment were lower than those before treatment,with statistical significance(total scores:F=19.29,P＜0.001;immediate memory score:F=6.22,P=0.020;language function score:F=9.13,P=0.006;attention score:F=5.23,P=0.031;delayed memory score:F=35.90,P＜0.001).There was no significant difference in the total scores and factor scores of RBANS before and after treatment in MST group(total scores:F=0.49,P=0.490;immediate memory score:F=2.25,P=0.147;language function score:F=1.22,P=0.280;attention score:F=0.23,P=0.640;delayed memory score:F=0.02,P=0.887).Conclusions The efficacy of MST treatment and MECT treatment in treating MDE patients seems to be comparable.MDE patients receiving MST had less impact on cognitive function compared to those treated with MECT.
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