Publication:

重度憂鬱症患者接受保健推拿個案分析研究

本研究旨在了解保健推拿介入重度憂鬱症患者接受治療的成效與如何操作以求發揮其效果，嘗試以非藥物、較少副作用方式來輔助治療憂鬱症。探討以保健推拿對重度憂鬱症患者是否能減輕其焦慮、失眠症狀，並改善其長期飽受肌肉疼痛之苦。本研究實驗樣本選取中山醫學大學附設醫院精神科門診及住院病人，年齡介於18歲到65歲且診斷符合美國精神醫學會第四版（DSM-IV）重度憂鬱症（major depressive disorder）診斷標準之病人，排除有其他精神疾病或頭部外傷、藥物濫用、酒精濫用史或明顯中風或骨折病史，並填寫參與同意書。實驗組之患者使用抗憂鬱劑加上保健推拿，對照組則單純使用抗憂鬱劑治療。每週實施一次，一次約20~30分鐘。研究前施測漢氏憂鬱量表（HAM-D）、漢氏焦慮量表（HAM-A）、簡易疼痛量表；於第一週、二週、四週、十二週再施測以上之量表，持續追蹤治療十二週。研究所得資料以Mann-Whitney test比較實驗組與對照組量表分數之差異，另外以Fisher’s exact test 比較病患基本人口資料對於保健推拿的介入施行是否因為個人的背景不同，而有任何差異存在。alpha值定為0.05，即P-value <0.05者即有顯著差異。最後收案為實驗組四名，對照組五名。研究結果顯示，四名重度憂鬱症個案共有的症狀為肌肉緊繃、酸痛、頭痛失眠，在實施保健推拿之後，都有肌肉放鬆之舒適感、入睡較容易。量表分數資料分析與病患口述資料對照分析，病患的真實感受忠實的反映在量表的分數上，當病患的肌肉酸痛、肌肉緊繃、頭痛、失眠等焦慮症狀減輕的時候，其焦慮量表分數也降低。因同時服用抗憂鬱藥物，其憂鬱量表分數也相對降低，在其簡易疼痛量表的分數更有明顯的反應。此研究雖無法排除抗憂鬱藥物能改善憂鬱、焦慮及疼痛症狀，但還是有可能在休閒活動中的保健推拿對重度憂鬱症患者在減輕其焦慮與失眠症狀有緩解效果，並能消弭其局部肌肉之緊張感。

The purpose of this study is to examine and identify the effectiveness of both health Tui-Na therapy in treating major depressive disorder and the appropriate clinical procedures of health Tui-Na to treat psychiatric illness with non-pharmacological, less side effect method. The study tried to investigate the effectiveness of health Tui-Na in reducing symptoms of anxiety, insomnia, and long term muscle strain in patients with major depressive disorder. Samples were selected from outpatients and inpatients of Department of Psychiatry in Chung Shan Medical University Hospital, aged between 18 and 65 years, with the diagnosis of major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Those who suffered from other psychiatric illness, neck injury, obvious stroke, history of bone fracture or alcohol and substance abuse were excluded. Cases received antidepressants and health Tui-Na therapy on a weekly basis with a session of twenty to thirty minutes Controls only received antidepressants. Scales such as Hamilton depression scale (HAM-D), Hamilton anxiety scale (HAM-A) and short-form pain assessment were also assessed during the initial study, first week, second week, forth week and the twelfth week. Differences of scores were analyzed by using Mann-Whitney Test. Some demographic data were analyzed by using Fisher’s Exact Test, to compare the differences between cases and controls. Alpha value was set to 0.05; and therefore a distinct disparity would be evident when P-value is less than 0.05. Total number of cases was 4 and 5 in controls. Result of this study indicated that all four cases had common symptoms of tense muscle, sore muscle, headache, and insomnia. However through therapy, the patients were able to feel relaxation of the muscles, and found themselves easier to fall asleep. Cases felt improved from muscle strain, headache, insomnia or anxiety, the scores for anxiety were also improved. Although this study can't exclude the drugs effect to anxiety, depression and pain, health Tui-Na does provide a possible effect in reducing the symptoms of anxiety and insomnia on patients with major depressive disorder.