双侧序贯rTMS联合米氮平治疗首发重度抑郁症的效果及对5-HT、DA、NE、睡眠质量的影响OA

Objective:To study the effectiveness of bilateral sequential repetitive transcranial magnetic stimulation(rTMS)combined with Mirtazapine in the treatment of first-episode major depressive disorder(MDD),and the influence on 5-hydroxytryptamine(5-HT),dopamine(DA),norepinephrine(NE)and sleep quality.Method:A total of 120 clinical patients who met the diagnosis of first-episode MDD and were treated in the Third People's Hospital of Ji'an from January 2022 to June 2023 were selected for the study,they were randomly divided into the control group 1,the control group 2 and the study group,with 40 patients in each group.All groups were treated with Mirtazapine,the control group 2 was treated with 10 Hz of rTMS on the left,and the study group was given with bilateral sequential treatment with 10 Hz and 1 Hz of rTMS,all patients were given 4 weeks of treatment.The three groups were compared in terms of the degree of depression[Hamilton depression scale(HAMD-17)]and sleep quality[Pittsburgh sleep quality index(PSQI)]before treatment and after 2 weeks and 4 weeks of treatment,clinical efficacy,and the incidence of adverse reactions[treatment emergent symptom scale(TESS)].The changes in serum 5-HT,DA and NE levels before and after treatment were recorded.Result:After 2 and 4 weeks of treatment,HAMD-17 scores of the three groups decreased.Besides,HAMD-17 scores of the study group were lower than those of the control group 1 and the control group 2,and HAMD-17 scores of the control group 2 were lower than those of the control group 1.The differences were statistically significant(P<0.05).After 2 and 4 weeks of treatment,PSQI scores of the three groups decreased,PSQI scores of the study group were lower than those of control group 1 and the control group 2,and PSQI scores of the control group 2 were lower than those of the control group 1,the differences were statistically significant(P<0.05).The clinical total effective rates in the study group was 90.00%,which was higher than 72.50%in the control group 2 and 60.00%in the control group 1,the differences were statistically significant(P<0.05).After treatment,serum 5-HT,NE and DA levels in the three groups were increased,serum 5-HT,NE and DA levels in the study group were higher than those in the control group 1 and the control group 2,serum 5-HT,NE and DA levels in the control group 2 were higher than those in the control group 1,the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion:Compared to treatment with Mirtazapine alone and drug combined with unilateral rTMS,bilateral sequential rTMS combined with drug therapy is more effective in the treatment of patients with first-episode MDD as it can effectively improve the patients'sleep quality and depressive symptoms,and promote neurotransmitter metabolism,with good safety.