| Background:Depression is a common mental disease,mainly manifested as emotional symptoms and cognitive impairment,which has a negative impact on patients’ occupational function and quality of life,and also brings a huge social burden.Currently,it has become one of the main causes of the global disease burden.In drug treatment,many patients have little effect and large side effects,so more effective means should be used for intervention.Repetitive transcranial magnetic stimulation(rTMS),a novel neuromodulation technique,has been widely used in the treatment of depression.However,the effects of different treatment modes and parameter Settings of rTMS on depressive symptoms and cognitive function remain controversial.Meanwhile,the pathogenesis of depression is still unclear,and previous studies suggest that it may be related to brain parenchymal damage and brain derived neurotrophic factor(BDNF)level.Neuron specific Enolase(NSE)level in serum can be used as a biological marker of brain parenchymal damage.At present,there is no consensus on the effect of rTMS on serum NSE and BDNF levels in patients with depression,which is also one of the current research hotspots.In this study,the effects of high-frequency repetitive transcranial magnetic stimulation combined with SSRI drugs on depression symptoms,cognitive function and serum BDNF and NSE levels were explored to explore a more optimized treatment mode,and the biological mechanism of rTMS in the treatment of depression.Objectives:1.To investigate the effect of high-frequency(10 Hz)repeated transcranial magnetic stimulation(rTMS)combined with SSRIs antidepressants on clinical efficacy and cognitive function in patients with depression.2.To investigate the effect of high-frequency(10 Hz)repeated transcranial magnetic stimulation(rTMS)combined with SSRIs antidepressants on serum brain derived neurotrophic factor(BDNF)and serum Neuron specific enolase(NSE)concentration in patients with depression.Methods:In this study,a randomized double-blind,pseudo-stimulation parallel control trial design method was used.A total of 60 patients aged 18-60 who met the ICD-10 criteria for depression were enrolled.They were randomly divided into treatment group and control group,30 cases in each group;The two groups received escitalopram oxalate tablets combined with 20 true and pseudo-stimulation treatments,respectively.The stimulation site was left dorsolateral prefrontal lobe,and the parameters were 10Hz and 110%MT.Antidepressant dosage was adjusted according to the condition during treatment.Patients were assessed with the Hamilton Depression Rating Scale(HAMD-17)at baseline,2 weekends and 4 weekends.The cognitive function of patients was assessed by Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)at baseline and 4 weekends.Serum BDNF and NSE levels were measured at baseline and 4 weeks.SPSS 25.0 software was used for statistical analysis,Per Protocol(PP)analysis and intention-to-treat(ITT)analysis were used to compare the therapeutic effect of depression between the two groups.Measurement data were compared between groups using independent sample T test or non-parametric test;Repeated measurement analysis of variance used to compare the measurement difference between groups at different time points.Chi-square test was used to compare the count data of patients,The correlation between HAMD,RBANS and BDNF and NSE was analyzed by Pearson correlation.P<0.05 was considered statistically significant.Results:1.54 patients completed the 4-week study,There was no significant difference in demographic data between the two groups.2.Comparison of cure rate and significant efficiency between the two groups:at the end of the 4th week of treatment,the significant efficiency of the treatment group was significantly higher than that of the control group,the difference was statistically significant(P=0.038).There was no significant difference in the cure rate between the two groups.A total of 60 patients screened were included in the intentionality analysis(ITT),and the significant efficiency of the treatment group was significantly higher than that of the control group,and the difference was statistically significant(P=0.020).There was no statistically significant difference in cure rate between the two groups.3.Comparison of HAMD-17 scales between the two groups:AN OVA results of repeated measurements of HAMD-17 score showed that the total score of HAMD-17 and the scores of different factors had significant time effect(P<0.05).H AMD-17 total scores and retardation score had significant interaction effect between time and group(P<0.05).The HAMD-17 total score in the treatment group was significantly lower than control group at second week and 4th week,and the difference was statistically significant(P=0.010;P<0.001),The retardation score was significantly lower in the treatment group than that in the control group at the end of second week,and the difference was statistically significant(P=0.041).There were no significant difference in anxiety/somatization,Cognition disturbance and weight scores between the two groups.4.Comparison of RBANS scores between the two groups:ANOVA results of repeated measurements of RBANS score showed that the total score,immediate memory,visual span,speech function and attention factor score had significant time effect P<0.05),The immediate memory,attention and total score had significant interaction effect between time and group(P<0.05).The immediate memory,attention factor and total score in the treatment group was significantly higher than control group at 4th week,and the difference was statistically significant(P=0.006;P=0.004;P=0.045).There were no statistical differences among time effect,time and group effect in the delayed memory scores.5.Comparison of BDNF scores between the two groups:ANOVA results of repeated measurements showed that BDNF level had significant time effect and interaction effect between time and groups(P<0.05).After 4 weeks,BDNF level in the treatment group was significantly higher than that in the control group,and the difference was statistically significant(P=0.046).6.Comparison of NSE levels between the two groups:ANOVA results of repeated measurements showed that NSE level had significant time effect(P<0.001).After 4 weeks,the NSE level in the treatment group was significantly lower than that in the control group,and the difference was statistically significant(P=0.027).7.Correlation analysis:Pearson bilateral significance test showed that the difference between HAMD total score and NSE before and after treatment was statistically significant and positively correlated(P=0.036).There was no obvious correlation among other indexes.Research Conclusions:rTMS combined with escitalopram oxalate can enhance antidepressant efficacy,improve cognitive function and increase serum BDNF level,reduce serum NSE level;The improvement in depressive symptoms may be related to decreased NSE levels. |
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