Clinical Study Of Low Frequency RTMS Combined With Duloxetine In The Treatment Of Depression With Somatic Symptoms

Objective: To investigate the clinical efficacy of low frequency repetitive transcranial magnetic stimulation combined with duloxetine in the treatment of depression with somatic symptoms,and to observe the effects on blood routine indexes and cognitive functionMethod: 107 hospitalized patients with depression with somatic symptoms treated in our hospital from December 2018 to August 2019 were selected,and randomly divided into observation group(54 cases)and control group(53 cases)by digital table method.Patients in observation group were treated with Low frequency r TMS combined with duloxetine,while patients in control group were treated with pseudo r TMS combined with duloxetine.After 8 weeks of continuous treatment,the platelet count(PLT)and mean blood count of patients in both groups were measured.Platelet distribution width(PDW),Platelet volume(MPV),neutrophil count(NEUT)and lymphocyte count(Lymphocyte,LYM)and the ratio of neutrophils to lymphocytes(Neutrophil To Lymphocyte Ratio,NLR)were calculated.Hamilton Depression Scale(HAMD-17)and Physical Symptom Severity Scale(PHQ-15)were used to evaluate the therapeutic effect of the two groups.The scores of each factor of HAMD were compared between the two groups.The cognitive function of the two groups was tested by Wisconsin Card Sorting Test(WCST),and the occurrence of adverse reactions was recorded.Adverse reactions during treatment were assessed by the side effect scale(TESS).Results:1.Within group comparison,showed that there was no significant difference in serum PLT between the two groups after treatment and before treatment(P>0.05),and the values of MPV,PDW and NLR in the two groups were lower than those before treatment,and the difference was statistically significant(P<0.05);after treatment,there was still no significant difference in serum PLT between the two groups(P>0.05),and the values of MPV,PDW and NLR in the observation group were significantly lower than those in the control group,and the differences were all significant.It was also statistically significant(P<0.05).2.The total effective rate of the observation group was 87.04%,significantly higher than 69.91% of the control group,the difference between the two groups was statistically significant(P<0.05);the PHQ-15 score of the observation group was significantly lower than that of the control group,and the difference between the two groups was also statistically significant(P<0.05).3.The scores of anxiety/somatization,cognitive impairment,block,sleep disorder and other factors in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).4.After treatment,the number of correct answers and the number of completed categories in the observation group were significantly higher than those in the control group,and the number of continuous answers,the number of wrong answers and continuous errors in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).5.In the treatment process,the observation group had headache,dizziness in 4 cases,lethargy in 3 cases,nausea in 2 cases,dry mouth in 2 cases,decreased libido in 1 case,diarrhea in 1 case,the incidence of adverse reactions was 24.07%;in the control group,there were 2 cases of headache,dizziness,4 cases of sleepiness,2 cases of insomnia,2cases of nausea,1 case of constipation,1 case of dry mouth,the incidence of adverse reactions was 22.64%,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).6.There was no significant difference in Tess score between the two groups at 2,4,6and 8 weeks of treatment(P>0.05).Conclusion:1.Low frequency r TMS combined with duloxetine is better than duloxetine in the treatment of depression with somatic symptoms.2.Low frequency r TMS can improve the cognitive function of depression patients with somatic symptoms.3.MPV,PDW and NLR values may be used as objective indicators to evaluate the severity of depression patients with somatic symptoms.