Abstract:

Objective　To analyze the efficacy of escitalopram combined with Shugan Jieyu capsule in the treatment of senile depression with insomnia. Methods　A total of 58 outpatients with senile depression and insomnia admitted to the First Affiliated Hospital of Nanyang Medical College from May 2021 to May 2023 were retrospectively selected and divided into control group and observation group according to different treatment methods, with 29 cases in each group. In the control group, there were 12 males and 17 females, aged (68.79±3.26) years old, and the course of disease was (12.57±2.45) months. The patients were treated with escitalopram orally, with an initial dose of 10 mg/d, and the dose was adjusted to 20 mg/d within 2 weeks. There were 14 males and 15 females in the observation group, aged (69.52±3.35) years old, and the course of disease was (12.82±2.34) months. Patients in the control group were po administered with Shugan Jieyu Capsules on the basis of the control group, 0.72 g/d, 2 times/d. All patients were treated continuously for 2 months.Clinical efficacy, psychological status [Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS) scores], sleep indicators (sleep onset time, total sleep time), Montreal Cognitive Assessment (MoCA) scores, neurochemical indicators [serotonin (5-HT), dopamine (DA), norepinephrine (NE)], Pittsburgh Sleep Quality Index (PSQI) scores, General Quality of Life Inventory (GQOLI-74) scores, and adverse reactions were compared between the two groups. Statistical analyses were performed using Fisher's exact test and t tests. Results　The total effective rate in the observation group was higher than that in the control group [96.55% (28/29) vs. 72.41% (21/29)], with a statistically significant difference (P=0.025). After 2 months of treatment, the SDS and SAS scores in the observation group were lower than those in the control group [(32.45±2.12) points vs. (38.26±2.43) points, (31.64±1.93) points vs. (37.58±2.12) points]. The observation group had a shorter sleep onset time compared to the control group [(30.58±3.24) min vs. (54.62±4.35) min] and a longer total sleep time [(6.71±1.35) h vs. (5.26±1.21) h]. The MoCA score in the observation group was higher than that in the control group [(28.23±1.04) points vs. (25.76±1.15) points]. The levels of 5-HT, DA, and NE in the observation group were (108.51±6.35) µg/L, (78.26±4.18) ng/L, and (10.12±0.64) mg/L, respectively, compared to (98.76±5.02) µg/L, (66.58±3.75) ng/L, and (9.35±0.58) mg/L in the control group. The PSQI score in the observation group was lower than that in the control group [(4.72±0.53) points vs. (7.25±0.62) points], while the GQOLI-74 score was higher in the observation group [(78.29±4.38) points vs. (70.35±4.12) points], with all differences being statistically significant (all P<0.05). The overall incidence of adverse reactions between the two groups was not statistically significant (P=1.000). Conclusion　Escitalopram combined with Shugan Jieyu capsule in the treatment of senile depression with insomnia can improve the clinical efficacy and reduce depression, Prolong sleep time, improve cognitive function, regulate neurotransmitter levels, Improve sleep quality, improve quality of life, and better safety.

Key words: Depressive disorder,  , Insomnia,  , The aged,  , Escitalopram oxalate,  , Shugan Jieyu , capsule

摘要：

目的　分析艾司西酞普兰联合舒肝解郁胶囊治疗老年抑郁症伴失眠患者的疗效。方法　回顾性选取2021年5月至2023年5月南阳医学高等专科学校第一附属医院收治的老年抑郁症伴失眠的门诊患者58例，按照治疗方法不同分为对照组和观察组，每组29例。对照组男12例、女17例，年龄（68.79±3.26）岁，病程（12.57±2.45）月；采用艾司西酞普兰治疗，口服，初期剂量10 mg/d，并在2周内调整剂量至20 mg/d。观察组男14例、女15例，年龄（69.52±3.35）岁，病程（12.82±2.34）月；在对照组基础上联合舒肝解郁胶囊治疗，口服，0.72 g/次，2次/d。所有患者均连续治疗2个月。对比两组临床疗效、心理状态［抑郁自评量表（SDS）、焦虑自评量表（SAS）评分］、睡眠指标（入睡时间、睡眠时间）、蒙特利尔认知评估量表（MoCA）评分、神经功能指标［5-羟色胺（5-HT）、多巴胺（DA）、去甲肾上腺素（NE）］、匹兹堡睡眠质量指数量表（PSQI）评分、生活质量综合评定问卷（GQOLI-74）评分、不良反应。采用Fisher精确概率检验、t检验进行统计分析。结果　观察组治疗总有效率高于对照组［96.55%（28/29）比72.41%（21/29）］，差异有统计学意义（P=0.025）。治疗2个月后，观察组的SDS、SAS评分均低于对照组［（32.45±2.12）分比（38.26±2.43）分、（31.64±1.93）分比（37.58±2.12）分］；观察组入睡时间比对照组短［（30.58±3.24）min比（54.62±4.35）min］，睡眠时间比对照组长［（6.71±1.35）h比（5.26±1.21）h］，MoCA评分高于对照组［（28.23±1.04）分比（25.76±1.15）分］；观察组的5-HT、DA、NE分别为（108.51±6.35）µg/L、（78.26±4.18）ng/L、（10.12±0.64）mg/L］，对照组上述指标分别为（98.76±5.02）µg/L、（66.58±3.75）ng/L、（9.35±0.58）mg/L；观察组的PSQI评分低于对照组［（4.72±0.53）分比（7.25±0.62）分］，GQOLI-74评分高于对照组［（78.29±4.38）分比（70.35±4.12）分］；差异均有统计学意义（均P<0.05）。两组不良反应总发生率差异无统计学意义（P=1.000）。结论　艾司西酞普兰联合舒肝解郁胶囊治疗老年抑郁症伴失眠患者，可提高临床疗效，减轻抑郁症状，延长睡眠时间，改善认知功能，调节神经递质水平，改善睡眠质量，提高生活质量，且安全性较佳。

关键词:  , 抑郁症,  ,  , 失眠,  ,  , 老年人,  ,  , 艾司西酞普兰,  ,  , 舒肝解郁胶囊