• 【单极抑郁症的文献治疗: 一项荟萃分析。】 复制标题 收藏 收藏
    DOI:10.1016/s0005-7916(97)00005-0 复制DOI
    作者列表:Cuijpers P
    BACKGROUND & AIMS: In the last decades, several therapies for unipolar depression have been developed, for example cognitive therapy, behavior therapy and pharmacotherapy. A new kind of therapy is bibliotherapy. What is new in this treatment modality is not the content, because bibliotherapy usually uses a cognitive-behavioral approach. Only the form in which it is presented is new. In bibliotherapy the patient takes a standardized treatment home, in book form, and works it through more or less independently. Contacts with therapists are only supportive or facilitative. No traditional relationship between therapist and patient is developed. In this article the relevance of bibliotherapy for the clinical practice is presented and a meta-analysis of the research into bibliotherapy is described.

    背景与目标: 在过去的几十年中,已经开发了几种针对单相抑郁症的疗法,例如认知疗法,行为疗法和药物疗法。一种新的疗法是书目疗法。这种治疗方式的新内容不是内容,因为书目疗法通常使用认知行为方法。只有呈现的形式是新的。在书目疗法中,患者以书本形式接受标准化治疗,并或多或少地独立进行治疗。与治疗师的接触只是支持性或促进性的。没有发展治疗师和患者之间的传统关系。本文介绍了书目疗法与临床实践的相关性,并描述了对书目疗法研究的荟萃分析。
  • 【老年抑郁症的结构神经影像学研究方法。】 复制标题 收藏 收藏
    DOI:10.1097/01.JGP.0000238588.34205.bd 复制DOI
    作者列表:Hoptman MJ,Gunning-Dixon FM,Murphy CF,Lim KO,Alexopoulos GS
    BACKGROUND & AIMS: :Geriatric depression consists of complex and heterogeneous behaviors unlikely to be caused by a single brain lesion. However, there is evidence that abnormalities in specific brain structures and their interconnections confer vulnerability to the development of late-life depression. Structural magnetic resonance imaging methods can be used to identify and quantify brain abnormalities predisposing to geriatric depression and in prediction of treatment response. This article reviews several techniques, including morphometric approaches, study of white matter hyperintensities, diffusion tensor imaging, magnetization transfer imaging, t2 relaxography, and spectroscopy, that have been used to examine these brain abnormalities with a focus on the type of information obtained by each method as well as each method's limitations. The authors argue that the available methods provide complementary information and that, when combined judiciously, can increase the knowledge gained from neuroimaging findings and conceptually advance the field of geriatric depression.
    背景与目标: : 老年抑郁症由复杂和异质的行为组成,不太可能由单个脑部病变引起。然而,有证据表明,特定大脑结构及其相互联系的异常使人们容易患上晚期抑郁症。结构磁共振成像方法可用于识别和量化易患老年抑郁症的脑部异常,并预测治疗反应。本文回顾了几种技术,包括形态计量学方法,白质高强度研究,扩散张量成像,磁化转移成像,t2弛豫成像和光谱学,这些技术已用于检查这些大脑异常,重点是获得的信息类型通过每种方法以及每种方法的局限性。作者认为,可用的方法提供了补充信息,并且如果明智地结合在一起,可以增加从神经影像学发现中获得的知识,并在概念上推进老年抑郁症领域。
  • 【睡眠剥夺与连续睡眠阶段提前相结合作为抑郁症的一种快速治疗方法: 一项在药物治疗和非药物治疗患者中的公开试点试验。】 复制标题 收藏 收藏
    DOI:10.1176/ajp.154.6.870 复制DOI
    作者列表:Berger M,Vollmann J,Hohagen F,König A,Lohner H,Voderholzer U,Riemann D
    BACKGROUND & AIMS: OBJECTIVE:The authors' goal was to test the hypothesis that the antidepressant effect of total sleep deprivation can be maintained by initially avoiding sleep during a supposedly "critical" time period in the early morning.

    METHOD:They studied 33 inpatients with major depression, melancholic type, all of whom responded positively to total sleep deprivation. Twelve of the patients were men and 21 were women; their mean age was 46.7 years (SD = 13.7). After total sleep deprivation, the patients started a sleep schedule from 5:00 p.m. to 12:00 midnight, which then was shifted back by 1 hour each day until a sleep time of 11:00 p.m. to 6:00 a.m. was reached.

    RESULTS:Twenty (61%) of the 33 patients who responded to total sleep deprivation with an improved state of mood maintained this improvement during sleep phase advance therapy. Drug-free and medicated patients did not differ from each other.

    CONCLUSIONS:The rapid amelioration of mood observed with total sleep deprivation can be preserved with a succeeding phase shift of the sleep period.

    背景与目标: 目的 : 作者的目标是检验以下假设: 完全睡眠剥夺的抗抑郁作用可以通过最初在清晨的一个所谓的 “关键” 时期避免睡眠来维持。
    方法 : 他们研究了33名患有抑郁症,忧郁型的住院患者,他们都对完全睡眠不足有积极的反应。12名患者为男性,21名患者为女性; 他们的平均年龄为46.7岁 (SD = 13.7)。完全睡眠剥夺后,患者开始从下午5:00到午夜12:00的睡眠计划,然后每天向后转移1小时,直到达到下午11:00上午6:00的睡眠时间。
    结果 : 33名对完全睡眠剥夺有改善的情绪状态有反应的患者中有20名 (61% 名) 在睡眠阶段提前治疗期间保持了这种改善。无药物和药物治疗的患者彼此之间没有差异。
    结论 : 完全睡眠剥夺所观察到的情绪迅速改善可以通过睡眠期的后续相移来保持。
  • 【安帕克因减轻大鼠呼吸抑制。】 复制标题 收藏 收藏
    DOI:10.1164/rccm.200606-778OC 复制DOI
    作者列表:Ren J,Poon BY,Tang Y,Funk GD,Greer JJ
    BACKGROUND & AIMS: RATIONALE:There is a need for improved therapeutic interventions to treat both drug- and sleep-induced respiratory depression. Increased understanding of the neurochemical control of respiration will help identify a basis for advances. Activation of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-type glutamate receptors positively modulates respiratory drive and rhythmogenesis in several brain regions including the pre-Bötzinger complex. Ampakines are a diverse group of small molecules that activate subsets of these receptors. OBJECTIVE:We determined whether the ampakine CX546 would enhance respiratory drive and rhythmogenesis across various stages of development and whether this ampakine could counter opioid- and barbiturate-induced respiratory depression. METHODS:Respiratory frequency and amplitude were measured in the following rat models: (1) perinatal in vitro brainstem-spinal cord, (2) neonatal in vitro medullary slice, (3) juvenile in situ perfused, working heart-brainstem preparation, and (4) newborn and adult in vivo. RESULTS:Administration of CX546 stimulated baseline respiratory frequency in perinatal in vitro preparations but not in older animals (greater than Postnatal Day 0). Furthermore, pharmacologic depression of respiratory frequency and amplitude was countered at all ages studied by the administration of CX546 in vitro, in situ, and in vivo. Significantly, CX546 countered opioid-induced breathing depression in all preparations, without altering analgesia as assessed by measuring the time to foot withdrawal in response to a thermal stimulus. CONCLUSIONS:CX546 effectively reverses opioid- and barbiturate-induced respiratory depression without reversing the analgesic response. These studies suggest that ampakines may be useful in preventing or reversing opioid-induced respiratory depression and identify the potential of ampakines for alleviating other forms of respiratory depression including sedative use and sleep apnea.
    背景与目标:
  • 【在轻度至重度创伤性脑损伤中,脑震荡后的主诉,焦虑和抑郁与职业结局有关。】 复制标题 收藏 收藏
    DOI:10.1016/j.apmr.2012.11.039 复制DOI
    作者列表:van der Horn HJ,Spikman JM,Jacobs B,van der Naalt J
    BACKGROUND & AIMS: OBJECTIVES:To investigate the relation of postconcussive complaints, anxiety, and depression with vocational outcome in patients with traumatic brain injury (TBI) of various severities and to assess sex differences. DESIGN:A prospective cross-sectional cohort study. SETTING:Level I trauma center. PARTICIPANTS:Adults (N=242) with TBI of various severity. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Extended Glasgow Outcome Scale, return to work (RTW), Head Injury Symptom Checklist, and Hospital Anxiety and Depression Scale. RESULTS:In 67% of the patients, complaints were present; 22% were anxious, and 18% were depressed. The frequency of complaints increased significantly with injury severity, in contrast to anxiety and depression. Frequencies of patients with anxiety and depression (9% and 5%) were lower with complete RTW than with incomplete RTW (42% and 37%; P<.001). Patients with minor TBI with complaints were more anxious (50% vs 27%; P<.05) and depressed (46% vs 23%; P<.05) compared with patients with other severity categories and patients with incomplete RTW (67% vs 36% and 60% vs 30%, respectively). A higher percentage of women with minor TBI were depressed (45% vs 13%; P=.01) and had incomplete RTW (50% vs 18%; P<.05) compared with men. Multiple regression analysis showed that injury severity, complaints, anxiety, and depression were all predictive of RTW (explained variance 45%). In all severity categories, anxiety and depression were predictive of RTW, complaints, and sex only for minor TBI. CONCLUSIONS:Anxiety and depression are related to vocational outcome after TBI, with a different profile in the minor TBI category, partly due to sex differences.
    背景与目标:
  • 【墨西哥裔美国人的抑郁、炎症和记忆力减退: 对可able队列的分析。】 复制标题 收藏 收藏
    DOI:10.1017/S1041610217001016 复制DOI
    作者列表:Johnson LA,Edwards M,Gamboa A,Hall J,Robinson M,O'Bryant SE
    BACKGROUND & AIMS: BACKGROUND:This study explored the combined impact of depression and inflammation on memory functioning among Mexican-American adults and elders. METHODS:Data were analyzed from 381 participants of the Health and Aging Brain study among Latino Elders (HABLE). Fasting serum samples were collected and assayed in duplicate using electrochemiluminesce on the SECTOR Imager 2400A from Meso Scale Discovery. Positive DepE (depression endophenotype) was codified as any score >1 on a five-point scale based on the GDS-30. Inflammation was determined by TNFα levels and categorized by tertiles (1st, 2nd, 3rd). WMS-III LMI and LMII as well as CERAD were utilized as measures of memory. ANOVAs examined group differences between positive DepE and inflammation tertiles with neuropsychological scale scores as outcome variables. Logistic regressions were used to examine level of inflammation and DepE positive status on the risk for MCI. RESULTS:Positive DepE as well as higher inflammation were both independently found to be associated with lower memory scores. Among DepE positive, those who were high in inflammation (3rd tertile) were found to perform significantly worse on WMS-III LM I (F = 4.75, p = 0.003), WMS-III LM II (F = 8.18, p < 0.001), and CERAD List Learning (F = 17.37, p < 0.001) when compared to those low on inflammation (1st tertile). The combination of DepE positive and highest tertile of inflammation was associated with increased risk for MCI diagnosis (OR = 6.06; 95% CI = 3.9-11.2, p < 0.001). CONCLUSION:Presence of elevated inflammation and positive DepE scores increased risk for worse memory among Mexican-American older adults. Additionally, the combination of DepE and high inflammation was associated with increased risk for MCI diagnosis. This work suggests that depression and inflammation are independently associated with worse memory among Mexican-American adults and elders; however, the combination of both increases risk for poorer memory beyond either alone.
    背景与目标:
  • 【海地地震后的精神病理学: 一项基于人群的创伤后应激障碍和严重抑郁症研究。】 复制标题 收藏 收藏
    DOI:10.1002/da.22007 复制DOI
    作者列表:Cerdá M,Paczkowski M,Galea S,Nemethy K,Péan C,Desvarieux M
    BACKGROUND & AIMS: BACKGROUND:In the first population-based study of psychopathology conducted in Haiti, we documented earthquake-related experiences associated with risk for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) 2-4 months following the 2010 Haiti earthquake. METHODS:A population-based survey was conducted of 1,323 survivors randomly selected from the general nondisplaced community, internally displaced persons camps, and a community clinic. Respondents were from the Nazon area of Port-au-Prince, ∼20 miles from the epicenter. RESULTS:Respondents (90.5%) reported at least one relative/close friend injured/killed, 93% saw dead bodies, and 20.9% lost their job post-earthquake. The prevalence of PTSD (24.6%) and MDD (28.3%) was high. History of violent trauma was associated with risk of PTSD and MDD (adjusted odds ratio [AOR] 1.4, 95% confidence interval [CI], 1.0-1.9; AOR, 1.7, 95% CI 1.3, 2.2, respectively). Low social support (AOR, 1.7, 95% CI 1.2, 2.3; AOR 1.4, 95% CI 1.0, 1.9, respectively) increased risk of PTSD and MDD among women. Suffering damage to the home increased risk of MDD in males (AOR 2.8, 95% CI 1.5, 5.5). Associations between being trapped in rubble, major damage to house, job loss, and PTSD; and participation in rescue/recovery, friends/family injured/killed, and MDD varied based on prior history of violent trauma. CONCLUSIONS:Addressing mental health in a post-earthquake setting such as Haiti will require focusing resources on screening and treatment of identified vulnerable groups while targeting improvement of post-earthquake living conditions. Investment in sources of social support for women may make help mitigate the vulnerability of women to PTSD and MDD.
    背景与目标:
  • 【慢性心脏病患者的抑郁和焦虑: 风险和预测因素的年龄差异。】 复制标题 收藏 收藏
    DOI:10.1002/nur.4770130205 复制DOI
    作者列表:Nickel JT,Brown KJ,Smith BA
    BACKGROUND & AIMS: :Anxiety and depression for 399 survivors of a 1,102-member heart disease cohort were assessed 8 to 9 years post-hospitalization. Approximately one-third reported symptoms of emotional distress and one-fourth were on anti-anxiety drugs. Predictors of anxiety and depression were analyzed through logistic regression. Subjects age 65 and over were less likely than younger patients to report anxiety or depression and also reported less heart-associated disability, the strongest predictor of distress for both age groups. Other significant predictors included a previous history of distress, low income, female sex, and beta blocker use.
    背景与目标: : 住院后8至9年评估了一个由1,102名成员组成的心脏病队列的399幸存者的焦虑和抑郁。大约3分之1个报告的情绪困扰和4分之1症状是使用抗焦虑药物。通过logistic回归分析焦虑和抑郁的预测因子。与年轻患者相比,65岁及以上的受试者报告焦虑或抑郁的可能性较小,并且与心脏相关的残疾也较少,这是两个年龄组中困扰的最强预测指标。其他重要的预测因素包括以前的困扰史,低收入,女性性别和使用 β 受体阻滞剂。
  • 【抑郁症和心血管疾病: 简单模型的终结。】 复制标题 收藏 收藏
    DOI:10.1192/bjp.bp.112.110502 复制DOI
    作者列表:de Jonge P,Roest AM
    BACKGROUND & AIMS: :In this editorial, we propose that the association between depression and cardiovascular disease may be conceptualised as a continuous, bidirectional process that originates in youth. The paper byÅberg and colleagues in this issue adds to this literature showing that low cardiovascular fitness at adolescence increases the risk of future depression.
    背景与目标: : 在这篇社论中,我们建议抑郁症与心血管疾病之间的关联可以概念化为一个持续的,双向的过程,起源于青年。这期的论文by å berg及其同事补充了这些文献,表明青春期心血管健康水平低会增加未来抑郁症的风险。
  • 【AGTR1与晚期抑郁症18个月治疗结果的关联。】 复制标题 收藏 收藏
    DOI:10.1097/JGP.0b013e31805470a4 复制DOI
    作者列表:Kondo DG,Speer MC,Krishnan KR,McQuoid DR,Slifer SH,Pieper CF,Billups AV,Steffens DC
    BACKGROUND & AIMS: OBJECTIVE:Converging lines of evidence implicate vascular factors in late-life depression, and argue that late-life depression is a distinct entity among the mood disorders. The A1166C polymorphism in the angiotensin II receptor, vascular type 1 (AGTR1) gene has been associated with a range of vascular diseases. This study investigated the association of AGTR1 genotype on 18-month treatment outcome in late-life depression. METHODS:In a large, prospective cohort study, patients with late-life depression received individualized treatment using a standardized algorithm. The authors genotyped participants at the AGTR1 A1166C single nucleotide polymorphism (SNP) using standardized methodology, then used survival analysis to estimate the impact of A1166C and demographic variables on time to remission during 18 months of follow-up. RESULTS:The hazard ratio for AGTR1 homozygous C/C status was 0.37. The A1166C SNP showed evidence for genotypic and allelic association in a comparison of remitted and unremitted/censored subjects. CONCLUSION:Consistent with its association with numerous vascular disorders, AGTR1 is associated with treatment outcome in late-life depression. Further studies are needed to replicate this finding, and to investigate the impact of other genetic markers of vascular disease on late-life depression outcome.
    背景与目标:
  • 【艾司西酞普兰治疗围绝经期抑郁症: 一项开放标签的初步研究。】 复制标题 收藏 收藏
    DOI:10.1089/jwh.2006.15.857 复制DOI
    作者列表:Freeman MP,Hill R,Brumbach BH
    BACKGROUND & AIMS: BACKGROUND:Women have a relatively high risk of experiencing depressive episodes during the perimenopause. Indications for and acceptance of hormone replacement therapy (HRT) are increasingly controversial, and serotonin reuptake inhibitor antidepressants are an attractive potential treatment option for both the mood and somatic symptoms of perimenopause. METHODS:This study is an open-label, 8-week trial of escitalopram for perimenopausal depression and somatic symptoms associated with perimenopause. Twenty women received escitalopram and were serially assessed with the Hamilton Rating Scale for Depression (HAMD, 30-item), the Greene Climacteric Scale (GCS), and the Clinical Global Impression (CGI). RESULTS:There were significant differences between pretest and posttest scores for each measure, as demonstrated in an intent-to-treat analysis: GCS (p < 0.0001), HAM-D30 (p < 0.0001), and CGI (p < 0.0001). Two subjects dropped out prior to the second visit because of drug side effects. In this study, benefits of treatment were observed in several domains of perimenopausal symptoms, including those representative of psychological, vasomotor, and somatic symptoms. The limitations of this study are small sample size and lack of placebo control. CONCLUSIONS:Larger, long-term, controlled trials of antidepressants are warranted for the treatment of perimenopausal depression and associated somatic symptoms.
    背景与目标:
  • 【5-羟色胺再摄取抑制剂治疗冠心病患者的抑郁症有多安全?】 复制标题 收藏 收藏
    DOI:10.1016/s0002-9343(96)00374-9 复制DOI
    作者列表:Sheline YI,Freedland KE,Carney RM
    BACKGROUND & AIMS: :Depression occurs frequently in patients with coronary heart disease (CHD), and confers significant risk for additional morbidity and mortality. The cardiac effects of the tricyclic antidepressants (TCAs) have been well characterized. In contrast, the cardiac effects of the selective serotonin reuptake inhibitors (SSRIs) have been less thoroughly investigated. The Medline database from 1986 to 1996 was searched for all reports of cardiac effects of SSRIs, and this literature is summarized. In addition, potential drug interactions, reports of side effects, and efficacy studies in the elderly are reviewed. Finally, recommendations are made considering the risk/benefit ratio.
    背景与目标: : 抑郁症经常发生在冠心病 (CHD) 患者中,并赋予额外发病率和死亡率的重大风险。三环抗抑郁药 (TCAs) 的心脏作用已得到很好的表征。相比之下,选择性5-羟色胺再摄取抑制剂 (SSRIs) 的心脏作用尚未得到彻底研究。在Medline数据库1986年1996年中搜索了SSRIs的所有心脏影响报告,并总结了这些文献。此外,还回顾了潜在的药物相互作用,副作用报告和老年人的疗效研究。最后,考虑风险/收益比提出建议。
  • 【对抑郁的反应及其对抑郁发作持续时间的影响。】 复制标题 收藏 收藏
    DOI:10.1037//0021-843x.100.4.569 复制DOI
    作者列表:Nolen-Hoeksema S
    BACKGROUND & AIMS: :I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.
    背景与目标: : 我建议人们对自己的抑郁症状的反应方式会影响这些症状的持续时间。对抑郁症进行反刍反应的人,专注于他们的症状以及症状的可能原因和后果,与采取行动分散自己的症状的人相比,抑郁症的时间将更长。反刍反应延长了抑郁症,因为它们使沮丧的情绪产生负面偏见,并干扰工具行为和解决问题的方法。直接测试该理论的实验室和现场研究支持了其预测。我讨论了应对方式如何解释女性比男性患抑郁症的可能性。然后,我将这种反应风格理论与应对离散事件的研究相结合。将反应风格理论与抑郁症持续时间的其他理论进行了比较。最后,我建议什么可以帮助抑郁症患者停止反刍反应,以及抑郁症的反应方式如何发展。
  • 【六项汉密尔顿抑郁量表的敏感性。】 复制标题 收藏 收藏
    DOI:10.1111/j.1600-0447.1997.tb09649.x 复制DOI
    作者列表:O'Sullivan RL,Fava M,Agustin C,Baer L,Rosenbaum JF
    BACKGROUND & AIMS: We studied the sensitivity in detecting changes of the 6-item version of the original 17-item Hamilton Depression Rating Scale (HAM-D) and compared it with the more widely used versions among 164 depressed outpatients with and without atypical features before and after treatment with fluoxetine. The 6-item HAM-D was shown to be as sensitive as the 17-, 21- and 24-item versions of this scale. In addition, the different versions of the HAM-D were strongly correlated with each other at baseline and at the endpoint. It appears that the 6-item version of the HAM-D allows the assessment of severity of depression with comparable sensitivity to the standard and more elaborate versions of the same scale.

    背景与目标: 我们研究了检测原始17项汉密尔顿抑郁量表 (ham-d) 的6项版本变化的敏感性,并将其与164例患有和没有非典型特征的抑郁症门诊患者中更广泛使用的版本进行了比较氟西汀治疗前后。显示6个项目的ham-d与该量表的17、21和24个项目版本一样敏感。此外,不同版本的ham-d在基线和终点彼此之间高度相关。看来,ham-d的6个项目版本可以评估抑郁症的严重程度,其敏感性与相同量表的标准版本和更精细的版本相当。
  • 【直流电疗法与艾司西酞普兰治疗抑郁症的试验。】 复制标题 收藏 收藏
    DOI:10.1056/NEJMoa1612999 复制DOI
    作者列表:Brunoni AR,Moffa AH,Sampaio-Junior B,Borrione L,Moreno ML,Fernandes RA,Veronezi BP,Nogueira BS,Aparicio LVM,Razza LB,Chamorro R,Tort LC,Fraguas R,Lotufo PA,Gattaz WF,Fregni F,Benseñor IM,ELECT-TDCS Investigators.
    BACKGROUND & AIMS: BACKGROUND:We compared transcranial direct-current stimulation (tDCS) with a selective serotonin-reuptake inhibitor for the treatment of depression. METHODS:In a single-center, double-blind, noninferiority trial involving adults with unipolar depression, we randomly assigned patients to receive tDCS plus oral placebo, sham tDCS plus escitalopram, or sham tDCS plus oral placebo. The tDCS was administered in 30-minute, 2-mA prefrontal stimulation sessions for 15 consecutive weekdays, followed by 7 weekly treatments. Escitalopram was given at a dose of 10 mg per day for 3 weeks and 20 mg per day thereafter. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS-17) score (range, 0 to 52, with higher scores indicating more depression). Noninferiority of tDCS versus escitalopram was defined by a lower boundary of the confidence interval for the difference in the decreased score that was at least 50% of the difference in the scores with placebo versus escitalopram. RESULTS:A total of 245 patients underwent randomization, with 91 being assigned to escitalopram, 94 to tDCS, and 60 to placebo. In the intention-to-treat analysis, the mean (±SD) decrease in the score from baseline was 11.3±6.5 points in the escitalopram group, 9.0±7.1 points in the tDCS group, and 5.8±7.9 points in the placebo group. The lower boundary of the confidence interval for the difference in the decrease for tDCS versus escitalopram (difference, -2.3 points; 95% confidence interval [CI], -4.3 to -0.4; P=0.69) was lower than the noninferiority margin of -2.75 (50% of placebo minus escitalopram), so noninferiority could not be claimed. Escitalopram and tDCS were both superior to placebo (difference vs. placebo, 5.5 points [95% CI, 3.1 to 7.8; P<0.001] and 3.2 points [95% CI, 0.7 to 5.5; P=0.01], respectively). Patients receiving tDCS had higher rates of skin redness, tinnitus, and nervousness than did those in the other two groups, and new-onset mania developed in 2 patients in the tDCS group. Patients receiving escitalopram had more frequent sleepiness and obstipation than did those in the other two groups. CONCLUSIONS:In a single-center trial, tDCS for the treatment of depression did not show noninferiority to escitalopram over a 10-week period and was associated with more adverse events. (Funded by Fundação de Amparo à Pesquisa do Estado de São Paulo and others; ELECT-TDCS ClinicalTrials.gov number, NCT01894815 .).
    背景与目标:

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