目的：探讨右侧低频经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）治疗对老年抑郁症 共病焦虑患者的疗效及安全性。方法：选取2021年1月至2021年6月在华中科技大学同济医学院附属梨园 医院精神科住院的老年抑郁症共病焦虑的患者72例，采用随机数字表法将患者分为对照组（35例）和低频 组（37例）。2组均接受抗抑郁药物治疗。在药物治疗基础上，低频组给予rTMS（1.0 Hz）治疗，刺激部位为 右侧背外侧前额叶皮质区，20 min/次，1 次/d，5 次/周，治疗4周，共20次；对照组给予相同时间和频次的伪刺 激治疗。在治疗前、治疗后1、2、3、4、6、8周末，采用汉密尔顿抑郁量表24项（HAMD-24）、汉密尔顿焦虑量 表14项（HAMA-14）评估2组患者焦虑、抑郁情况及治疗有效率，并进行组间比较，同时记录2组患者不良反 应；采用重复测量方差分析对不同时间点2组患者焦虑抑郁评分进行比较。结果：2组的HAMD-24评分、 HAMA-14评分的时间主效应、组间主效应、时间*组间互交效应具有统计学意义（P＜0.05）。进一步进行简 单效应分析结果显示，治疗1、2、3、4、6、8周时，2组HAMD-24评分均低于治疗前（P＜0.01）；治疗前、治疗1、 2、3、4周时，2组间HAMD评分差异无统计学意义（P＞0.05）；治疗6周时，低频组HAMD-24评分显著低于 对照组（P＜0.01）；在治疗8周时，低频组HAMD-24评分低于对照组（P＜0.05）。治疗1、2、3、4、6、8周时，2 组的HAMA-14评分均显著低于治疗前（P＜0.01）；治疗1、2周时，低频组HAMA-14评分低于对照组（P＜ 0.05），治疗3、4、5、6、8周时，低频组HAMA-14评分显著低于对照组（P＜0.01）。治疗4周后，低频组的总有 效率高于对照组（P＜0.05）；治疗6周后，低频组的显效率高于对照组（P＜0.05）；治疗8周后，2组的显效率 差异无统计学意义（P＞0.05）。2组治疗过程中未出现严重不良反应。结论：抗抑郁药联合右侧rTMS治疗 可有效缓解老年抑郁症共病焦虑患者焦虑抑郁症状，且优于单纯抗抑郁药物治疗，且安全性高。

To explore the efficacy and safety of right-sided low-frequency repetitive transcranial magnetic stimulation (rTMS) in treating depression comorbid with anxiety in elderly patients. Methods: A total of 72 elderly patients with depression comorbid with anxiety, hospitalized in the Department of Psychiatry of Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2021 to June 2021, were selected and randomly divided into a control group (35 cases) and a low-frequency group (37 cases) using a random number table. Both groups received antidepressant medication. Additionally, the low-frequency group was treated with rTMS (1.0 Hz) on the right dorsolateral prefrontal cortex, 20 minutes per session, once daily, five times per week, for a total of 20 sessions over 4 weeks. The control group received sham stimulation with the same duration and frequency. The Hamilton Depression Rating Scale-24 (HAMD-24) and the Hamilton Anxiety Rating Scale-14 (HAMA-14) were used to evaluate anxiety and depression symptoms and treatment efficacy at baseline and at the end of weeks 1, 2, 3, 4, 6, and 8. Adverse reactions were recorded, and repeated measures ANOVA was used to compare the scores of anxiety and depression between the two groups at different time points. Results: The main effects of time, group, and time-group interaction for HAMD-24 and HAMA-14 scores were statistically significant (P<0.05). Further analysis showed that HAMD-24 scores in both groups were significantly lower than baseline at weeks 1, 2, 3, 4, 6, and 8 (P<0.01). There was no significant difference in HAMD-24 scores between the two groups at weeks 1, 2, 3, and 4 (P>0.05), but the low-frequency group had significantly lower HAMD-24 scores than the control group at week 6 (P<0.01) and week 8 (P<0.05). For HAMA-14 scores, both groups showed significant reductions compared to baseline at weeks 1, 2, 3, 4, 6, and week 8 (P<0.01). The low-frequency group had significantly lower HAMA-14 scores than the control group at weeks 1 and 2 (P<0.05) and at weeks 3, 4, 6, and 8 (P<0.01). After 4 weeks of treatment, the overall response rate in the low-frequency group was higher than that in the control group (P<0.05). After 6 weeks, the marked improvement rate in the low-frequency group was significantly higher (P<0.05), but there was no significant difference in marked improvement rates between the two groups after 8 weeks (P>0.05). No severe adverse reactions were observed in either group. Conclusion: Combined antidepressant and right-sided rTMS therapy effectively alleviates both depressive and anxiety symptoms in elderly patients with comorbid depression and anxiety, demonstrating superiority to antidepressant medication alone while maintaining a favorable safety profile.