University of Toronto, Department of Psychiatry, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Harquail Centre for Neuromodulation, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; University of Toronto, Department of Surgery, 149 College Street, Toronto, Ontario M5T 1P5, Canada.
J Affect Disord. 2023 Jan 1;320:716-724. doi: 10.1016/j.jad.2022.09.153. Epub 2022 Oct 4.
History of adverse childhood experiences (ACEs) is associated with poorer treatment outcomes in depression. How ACEs affect outcomes from repetitive transcranial magnetic stimulation (rTMS) is not well-defined. The primary aim was to investigate whether ACEs affect depression outcomes in patients receiving high frequency rTMS, either deep TMS (dTMS) or intermittent theta burst stimulation (iTBS), to the left dorsolateral prefrontal cortex.
The Hamilton Depression Rating Scale (HAMD-17) was collected at baseline and every 2 weeks for 4-6 weeks. Outcomes included improvement in HAMD-17 and remission. The ACE-10 questionnaire was used to quantify categories of ACEs. Data from 99 patients with MDD receiving an acute rTMS course were analyzed.
Patients had a mean of 2.4 ACEs (SD 2.5). No significant differences in outcomes were found between dTMS or iTBS so these data were pooled. Using a continuous ACE variable showed no significant impact on outcomes. Using a categorical ACE variable (0, 1, 2, 3, 4 or more) did not reveal significant effects of ACEs on outcomes. Higher ACE was associated with steeper decrease in HAMD-17 only from baseline to week 2 but not at other times.
This was an open-label study. The well-validated ACE questionnaire does not measure severity or frequency of adversities.
Patients with depression receiving rTMS reported on average 2.4 ACEs. ACE scores may lead to a steeper early decline in HAMD-17 but did not otherwise impact depression outcomes. Presence of high levels of ACEs should not preclude consideration of rTMS for depression.
不良童年经历（ACEs）与抑郁症的治疗结果较差有关。ACEs 如何影响左背外侧前额叶重复经颅磁刺激（rTMS）的结果尚不清楚。主要目的是调查 ACEs 是否会影响接受高频 rTMS（深 TMS（dTMS）或间歇性 theta 爆发刺激（iTBS））的患者的抑郁结果。
基线时和 4-6 周内每 2 周收集汉密尔顿抑郁评定量表（HAMD-17）。结果包括 HAMD-17 的改善和缓解。使用 ACE-10 问卷来量化 ACE 类别。分析了 99 例接受急性 rTMS 疗程的 MDD 患者的数据。
患者的 ACE 平均值为 2.4（SD 2.5）。dTMS 或 iTBS 之间的结果无显着差异，因此将这些数据合并。使用连续 ACE 变量显示对结果没有显着影响。使用分类 ACE 变量（0、1、2、3、4 或更多），ACE 对结果没有显着影响。较高的 ACE 仅与基线至第 2 周期间 HAMD-17 的急剧下降相关，但在其他时间没有。
这是一项开放标签研究。经过充分验证的 ACE 问卷无法衡量逆境的严重程度或频率。
接受 rTMS 的抑郁症患者平均报告了 2.4 次 ACE。ACE 评分可能导致 HAMD-17 早期急剧下降，但不会影响抑郁结果。高水平的 ACE 不应排除考虑 rTMS 治疗抑郁症。
