Impact of Comorbid Posttraumatic Stress-Related Symptoms on Repetitive Transcranial Magnetic Stimulation for Depression in Civilians: Incidence des symptômes du trouble de stress post-traumatique (TSPT) comorbide sur la stimulation magnétique transcrânienne répétitive pour traiter la dépression.

Abstract

ObjectivesThe impact of comorbid posttraumatic stress disorder (PTSD) symptoms on the anti-depressive outcomes of repetitive transcranial magnetic stimulation (rTMS) for civilians with major depressive disorder (MDD) is poorly studied. We aimed to understand whether proximal PTSD symptoms would interact with distal traumas in impacting depression outcomes from rTMS treatment.MethodsA retrospective analysis was performed on 133 patients with MDD receiving open-label high-frequency rTMS to the left dorsolateral prefrontal cortex for 4 weeks. Probable PTSD was defined as scoring ≥ 4 on the Primary Care PTSD Screen for DSM-5. Distal traumas were quantified using the Adverse Childhood Experiences (ACE-10) questionnaire. Primary outcomes were improvement in Hamilton Rating Scale for Depression 17 item scale (HAMD-17) scores from baseline to 4 weeks as well as remission (HAMD-17 ≤ 7) and response (greater than 50% improvement from baseline).Results29/133 had probable PTSD. Patients with probable PTSD had more ACEs, as well as higher depression, anxiety and medical comorbidity scores. Neither probable PTSD status nor its interaction with ACEs significantly impacted depression outcomes. However, having more ACEs was associated with greater odds of remission and response.ConclusionsOur findings suggest neither co-morbid PTSD symptoms nor distal childhood adversities should preclude patients with MDD from receiving rTMS for depression.