A randomize controlled trial of early response between repetitive transcranial magnetic stimulation and modified electroconvulsive therapy in patients with first-episode depression / 中国心理卫生杂志

ABSTRACT

Objective:To explore the differences of the early response time between transcranial magnetic stimulation (rTMS ) and modified electroconvulsive therapy (MECT )in patients with first-episode depression.Methods:Totally 65 first-episode patients aged 18 -45 year were enrolled in the study.The diagnoses were made according tothe Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-Ⅳ)criteria for depression.The patients randomly received rTMS(n =33)or MECT (n =32).All patients received co-therapy of escitalopram (10 -20 mg /day).Stimulation (20 Hz)was performed five times a week for four weeks and,a total of 20 consecutive working days over the left dorsolateral prefrontal cortex(DLPFC).MECT group received MECT treatment 3 times a week for 3 weeks,a total of eight times.The Hamilton Depression Rating Scale-24 items (HAMD)was used to assess the severity of clinical symptoms and reduction rates.Results:Compared with the pa-tients in MECT group,the patients in rTMS group showed a less reduction rates [(25.0.±3.1),(34.4 ±7.7), (52.2 ±7.8),(69.1 ±8.3),vs(28.2 ±5.4),(38.8 ±5.1 ),(57.7 ±6.8),(75.4 ±8.6),Ps <0.05]in the first four weeks and the suicidal behavior scores reduced less in rTMS group in the first two weeks (P <0.05).Conclu-sion:It suggests that both rTMS at 20 Hz and MECT combined with escitalopram could improve the first-episode depression within a week.While the efficacy of rTMS combined with escitaloprm slightly less than MECT com-bined with essitaloprm in rapid response and reducing the suicide risk of acut period.