rTMS 联合 tDCS 对于抗抑郁剂治疗抑郁症的加强作用及其 脑电机制
文献类型：学位论文
| 作者 | 魏硕池
|
| 答辩日期 | 2022-06 |
| 文献子类 | 硕士 |
| 授予单位 | 中国科学院大学 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 张向阳 |
| 关键词 | 重复经颅磁刺激（rTMS） 经颅直流电刺激（tDCS） 抑郁症 物理 治疗 脑电技术 |
| 学位名称 | 理学硕士 |
| 学位专业 | 健康心理学 |
| 其他题名 | The Add-on Role of Combined Transcranial Magnetic Stimulation Combined with Transcranial Direct Current Stimulation on Depressive Disorders and Related Electroencephalographic Mechanism |
| 中文摘要 | Objective: Depression is a common mental disorder with a high incidence in China. The current treatment for depression mainly includes pharmacotherapy, psychotherapy and physical therapy. Non-invasive brain stimulation technique, as a new physical therapy technique, can directly modulate the cerebral cortex. Physiotherapy techniques represented by transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are now widely used in the treatment of depression. In this study, we combined the two therapeutic techniques and used a combined protocol of transcranial magnetic stimulation combined with transcranial direct current stimulation to intervene in the treatment of depressed patients to examine the therapeutic effects and electroencephalographic mechanisms. Methods: This study consisted of two parts that examined the efficacy and electroencephalographic mechanisms of the combined treatment at the clinical and brain levels. Study one examined the clinical efficacy of rTMS combined with tDCS in the treatment of depression. Subjects were assigned to four treatment regimen groups for a total of 10 sessions over 2 weeks: rTMS combined with tDCS treatment, rTMS +sham tDCS treatment, sham rTMS + tDCS treatment, and sham rTMS + sham tDCS treatment groups. A single-blind randomized controlled experimental design was used, and only the experimental investigator was clear about the enrollment of the subjects; neither the subjects nor the evaluators were clear about which treatment the subjects received. The Hamilton Depression and Anxiety Inventory was used to assess the subjects' clinical symptoms. Study 2 used transcranial magnetic stimulation-electroencephalography (TMS-EEG) technique to explore the electroencephalographic mechanisms of rTMS combined with tDCS in the treatment of depression. Subjects underwent TMS- EEG data acquisition at both baseline and post-test, which was used to compare the changes in TMS-evoked EEG signal activity before and after treatment, and to compare the differences in EEG signals between the four treatment groups at post-test, in order to establish the relationship between EEG signals and depressive symptoms and explore the electroencephalographic mechanisms behind the remission of depressive symptoms. Results: The results of Study 1 showed that the rTMS combined with tDCS treatment group had the greatest reduction in Hamilton Depression Inventory scores and the least severe depression after 2 weeks of treatment, with higher remission and response rates. The results suggest that rTMS combined with tDCS treatment can accelerate the improvement of depressive symptoms after two weeks of treatment. Study 2 results showed that after 2 weeks of treatment, subjects experienced different degrees of reduction reductions in N45, N100, P60 and P180 amplitudes, and the P60 amplitude was significantly smaller in the rTMS combined with tDCS treatment group than in the sham rTMS + sham tDCS group, and the P180 amplitude in the rTMS combined with tDCS treatment, rTMS + sham tDCS and sham rTMS + sham tDCS groups. P180 amplitude in the rTMS combined with tDCS treatment group, rTMS + sham tDCS group and sham rTMS + sham tDCS group were significantly smaller than that in the sham rTMS + tDCS group. The findings suggest that the rTMS combined with tDCS treatment group may achieve the improvement of depression by effectively modulating the cortical excitability mechanism. Conclusion: rTMS combined with tDCS treatment can effectively alleviate depressive symptoms and can produce better efficacy at 2 weeks compared to single physical therapy regimen. rTMS combined with tDCS treatment for depression involves electroencephalographic mechanisms that modulate abnormal excitatory and inhibitory mechanisms in the brain, thus providing relief from clinical symptoms. |
| 英文摘要 | 目的：抑郁症是一种常见的精神障碍，在我国具有较高的发病率。目前对于抑郁症的治疗主要包括药物治疗、心理治疗以及物理治疗。非侵入性脑刺激技术作为一种新型的物理治疗技术，可以直接对大脑皮层进行调控。以经颅磁刺激和经颅直流电刺激为代表的物理治疗技术目前被广泛地用于抑郁症的治疗中。本研究将两种治疗技术结合，采用经颅磁刺激联合经颅直流电刺激的合并方案，对抑郁症患者进行干预治疗，考察其治疗效果和脑电机制。 方法：本研究包括两个部分，从临床和脑的层面探讨了联合治疗的疗效与脑电机制。研究一考察 rTMS 联合 tDCS 治疗抑郁症的临床疗效。将被试分到四种治疗方案组中接受为期 2 周共 10 次的治疗，分别为 rTMS 联合 tDCS 治疗、rTMS+tDCS 伪刺激治疗、rTMS 伪刺激+tDCS 治疗以及 rTMS 伪刺激+tDCS 伪刺激治疗组。采用单盲的随机对照实验设计，只有实验研究者清楚被试的入组情况，被试和评估者均不清楚被试接受的是哪种治疗。采用汉密尔顿抑郁和焦虑量表评估被试的临床症状。研究二采用经颅磁联合脑电图 TMS-EEG 技术来探索 rTMS联合 tDCS 治疗抑郁症的脑电机制。被试在基线和后测时都会接受 TMS 联合脑电图的数据采集，用来比较治疗前后 TMS 诱发脑电信号活动的变化，并且对比四种治疗组在后测时脑电信号的差异，以此建立脑电信号与抑郁症状之间的关系，探索抑郁症状缓解背后的机制。 结果：研究一结果显示，在接受了 2 周的治疗后 rTMS 联合 tDCS 治疗组的汉密尔顿抑郁量表减分最多，抑郁严重程度最轻，具有更高的缓解率和响应率。结果提示了 rTMS 联合 tDCS 治疗可以在两周的治疗后产生更明显的抑郁症状改善。研究二结果显示，经历 2 周的治疗后，被试在 N45、N100、P60 和 P180 振幅方面有不同程度的减小，并且 rTMS 联合 tDCS 治疗组的 P60 振幅显著小于rTMS 伪刺激+tDCS 伪刺激组，rTMS 联合 tDCS 治疗组、rTMS+tDCS 伪刺激组和 rTMS 伪刺激+tDCS 伪刺激组的 P180 振幅显著小于 rTMS 伪刺激+tDCS 组。研究结果提示了 rTMS 联合 tDCS 治疗组可能通过有效地调节大脑皮层兴奋性机制来达到改善抑郁的作用。 结论：rTMS 联合 tDCS 治疗可以有效缓解抑郁症状，并且相比于单一物理治疗方案可以在 2 周时产生更明显的改善，提示了联合治疗的加强作用。rTMS 联合 tDCS 治疗抑郁症的脑电机制涉及到调整大脑异常的兴奋和抑制机制，提示可能与加速缓解临床症状有关。 |
| 语种 | 中文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/43136]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | 魏硕池. rTMS 联合 tDCS 对于抗抑郁剂治疗抑郁症的加强作用及其 脑电机制[D]. 中国科学院心理研究所. 中国科学院大学. 2022. |
入库方式： OAI收割
来源：心理研究所
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