健康与遗传心理学研究室知识库

抑郁症是常见的精神疾病之一，且往往伴随认知损伤，会严重影响患者的社会功能和生活质量，但目前仍缺乏有效的治疗方法。而经颅交流电刺激 (tACS)是一种新兴的干预技术，可以通过对大脑振荡的改变而起到调节大脑皮层的效果，广泛用于精神疾病的治疗之中，但其被应用于治疗抑郁症的实践相对较少。据调查所知，应用y波段tACS改善抑郁症患者认知损伤研究均为案例报告，缺乏随机对照研究。值得注意，大多数研究只关注宏观层面变化而缺乏起效机制探索。因此，本研究旨在采用y -tACS对抑郁症患者进行干预，并评估其干预效果，最后尝试使用近红外脑成像技术(fNIRS)对其机制进行探索。

研究一，共55名抑郁症患者参与为期两周的随机对照试验，并被随机分入两组(y -tACS刺激组与伪刺激组)。参与者10天内共接受20次治疗。入组前和干预结束后，本研究使用了汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)和汉密尔顿焦虑量表(Hamilton Anxiety Scale, HAMA)评估其抑郁症状及伴随发生的焦虑症状。用重复性成套神经心理状态测验(Repeatable Battery for the Assessment of Neuropsychological Status, RBANS)评估患者基线 和两周后认知功能。结果显示，干预结束后y -tACS组患者RBANS总分、即刻记忆和延迟记忆子维度改善显著大于假刺激组(所有p <0.05 ) o y -tACS组认知功能增长值与焦虑症状的减分值正相关，与抑郁症状的改变无显著相关。然而，临床症状缓解，tACS组并不优于伪刺激组。

研究二，在研究一进行的同时，采集两组被试在基线和后测时的fNIRS结果，比较干预前后血氧信号活动变化，以期建立症状缓解与皮层兴奋性变化的关系，探索tACS潜在机制。fNIRS结果显示，后测相较于基线，tACS组位于额叶单个通道氧合血红蛋白信号变化(} avg oxy-Hb )差异显著，而伪刺激组两个颗叶区域通道显示出明显高于基线时的△avg oxy-Hb。但尚无通道的结果能通过FDR矫正。同时，根据指定兴趣区(ROI )分析时，任何脑区△avgoxy-Hb在前后测上均无明显差异。

综上，本研究首次以严格的随机对照研究同时探索y -tACS对于抑郁症患者的认知功能和临床症状的疗效。我们的结果表明y -tACS是一种有希望提高抑郁症患者认知能力的方法。但本研究尚未发现fNIRS方面的证据。我们的结果仍然为tACS在临床治疗上的应用和推广提供了一定的指导意义。

Depression is a common mental disorders, which often combined with cognitive impairment. It can severely affect social functioning and impair quality of life of paitients, but effective treatment options are limited. Transcranial Alternating Current Stimulation (tACS) is a novel intervention technique that can modulate the cortical function of the brain by changing brain oscillations and has been widely used in treating psychiatric disorders. However, its application in the treatment of depression is relatively rare. To our knowledge, the results of applicating y-tACS to improve cognitive impairment in patients with depression are all from case reports, lacking randomized controlled studies. Notably, most studies only focus on behavior-level changes without exploring the underlying mechanisms. Therefore, we aimed to investigate the effectiveness and safety of y-tACS to improve cognitive impairment and clinical symptoms in depressed patients.

In Study 1，a total of 55 patients with depression participated in a two-week randomized controlled trial and were randomly assigned to two groups(y -tACS group, sham group). Participants received a total of 20 treatment sessions in 10 days. Before and after the intervention, we conducted the 24-item Hamilton Depression Scale (HAMD-24) and the Hamilton Anxiety Scale (HAMA) to evaluate the patients' depressive and co-occurred anxiety symptoms. A Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was performed to assess patients' cognitive functions at baseline and week 2. The results showed that the y -tACS group had significantly greater improvements in RBANS total score, immediate memory and delay memory index than the sham group after treatment (all p<0.05). In y -tACS group, the growth score of cognitive function was positively correlated with the reduction score of anxiety symptoms following tACS, but not significantly correlated with the change of depression scores. However, y -tACS was not superior to the sham group in terms of clinical symptoms relief.

In Study 2, while Study 1 was being conducted, the baseline and post-test fNIRS results of the two groups were also collected to compare changes in blood oxygen signals following the intervention. We aimed to establish the relationship between symptom relief and cortical excitability enhancement and explore the potential mechanisms of tACS. The fNIRS results revealed a significant oxygenated hemoglobin signal change (}avg oxy-Hb) in one channel located in the frontal lobe of the tACS group between baseline and week 2, while two channels located in the temporal lobe area of the sham group showed significantly higher }avg oxy-Hb. However, no channel showed significant results after FDR correction. In addition, when analyzed according to the specified region of interest (ROI), there were no significant differences in the }avg oxy-Hb in any brain region.

In summary, this study is the first one to explore the effects of y -tACS on cognitive function and clinical symptoms in patients with depression using a strict randomized controlled design. Our results suggest that y -tACS is a promising approach to enhance cognitive performance in depression patients. However, this study doesn't provide supporting fNIRS evidence that tACS can modulate brain function. Our results still provide some guidance for the application and promotion of tACS in clinical treatment.