Clinical Observation Of High And Low Frequency Repetitive Transcranial Magnetic Stimulation Combined With Sertraline In The Treatment Of Adolescent Depression

Objective:Based on using sertraline hydrochloride,the purpose of this study was to compare the efficacy,safety,tolerance and thyroid hormone levels of high frequency left repetitive transcranial magnetic stimulation and low frequency right repetitive transcranial magnetic stimulation in adolescent patients with depression,trying to provide a basis for the frequency selection of repetitive transcranial magnetic stimulation in clinic.Methods:1.It is proposed to select 102 patients who meet the inclusion criteria from the Department of Psychosomatic Medicine of the first affiliated Hospital of Nanchang University from January 1,2022 to December 31,2022.The patients were divided into high frequency and low frequency treatment groups and put into pairs.The patients in both groups were treated with sertraline hydrochloride,and the dose was adjusted by the competent physician according to their condition.Excluding the shedding patients,there were 47 patients in the high frequency group and 46 patients in the low frequency group.2.In the high frequency group,the stimulating point was the left dorsolateral prefrontal cortex(DLPFC)with a stimulating frequency of 10 Hz,while in the low frequency group,the stimulating point was in the right dorsolateral prefrontal cortex with a frequency of 1Hz.Patients in both groups were treated once a day and 6 times a week according to their patterns,for a total of 24 times for 4 weeks.3.Each patient was asked to fill in a self-designed general demographic questionnaire and evaluated by 24 items of Hamilton Depression scale(HAMD-24),Hamilton anxiety scale(HAMA),Baker suicidal ideation scale(BSS)and Pittsburgh Sleep Index(PSQI)at the baseline,2 and 4 weeks after treatment.At the same time,the levels of free triiodothyronine(FT3),free thyroxine(FT4)and thyroid stimulating hormone(TSH)were measured at the baseline and at the end of 4 weeks of the treatment.At the same time,the side effects of patients were observed.4.The data were inputted by Excel form and statistically analyzed by SPSS25.0software.The measurement data of normal distribution are measured by paired t-test or the repeated measures analysis of variance,and the counting data are measured by chi-square test.The test level α = 0.05.Conclusion:1.Comparison before the intervention: the distribution of sex,age,years of education,baseline scores of thoes scales and thyroid hormone in high frequency group and low frequency group were compared with each other,the results showed that there was no significant difference(P > 0.05).2.Comparison between datas before having the intervention and after having them: With the passage of time,the total scores of HAMD,HAMA,BSS,PSQI and each factor score of the two groups showed a downward trend,and the intra-group scores of each scale decreased significantly after the treatment compared with the baseline level(P < 0.05).The levels of FT3 and FT4 in the two groups were higher than themselves at the baseline at the end of 4 weeks(P < 0.05),and there was no significant change in TSH level(P > 0.05).3.Comparison after intervention: there was no significant difference in the scores of each scale between the two groups at the end of the 2nd and 4th week of treatment(P > 0.05),and there was also no significant difference in the level of thyroid hormone between the two groups at the end of the 4 weeks of the treatment(P >0.05).4.Comparison of the difference-value:comparing two groups with each other,the difference of difference-value between the two groups was not statistically significant(P > 0.05),except for the ’ baseline-2 weekend ’ of the HAMA(P < 0.05).5.It is found that the adverse reactions between the two groups have got no significant difference(P > 0.05).Results:1.The treatment regimen of high-frequency left r TMS and low-frequency right r TMS combined with sertraline,respectively,showed significant improvements in adolescents’ depressive symptoms,anxiety symptoms,suicidal ideation,and sleep quality,and they had similar effect.2.The treatment regimen of high frequency left r TMS and low frequency right r TMS combined with sertraline was safe and mild,and there was no significant difference in safety and tolerance between them.3.The levels of FT3 and FT4 in adolescent patients with depression changed after intervention,which may have a certain predictive effect on the severity of symptoms and the recovery of the patients.