CURRENT POST-TRAUMATIC STRESS-RELATED SYMPTOMS AND DEPRESSION OUTCOMES FROM REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN CIVILIANS
Notice bibliographique
Résumé
Abstract Background There are mixed results on the impact of co-morbid post-traumatic stress disorder (PTSD) on the effect of repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) in military veterans. Some find PTSD status does not affect improvement in depressive symptoms while others find PTSD predicts poorer response and remission [1–3]. The impact of PTSD symptoms on the anti-depressive effects of rTMS for civilians remains poorly studied. Aims & Objectives Our primary aim was to test the impact of current PTSD symptoms on depressive outcomes among civilians receiving rTMS for depression. A secondary aim was to explore potential interaction with adverse childhood experiences (ACEs). Method A retrospective analysis was performed on patients with MDD receiving open-label high frequency rTMS to the left dorsolateral prefrontal cortex. Primary outcomes were improvement in the Hamilton Depression Rating Scale (HAMD-17) from baseline and remission (HAMD-17 score 7 or less) at end-of-acute treatment (4 or 6 weeks) of rTMS. Probable PTSD status was defined as scoring 4 or 5 in the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Categories of ACEs were quantified using the ACE-10 questionnaire. Baseline characteristics were compared using the t-test or the chi-square test. Multiple linear regression and multiple logistic regression were used to model the impact of PTSD status, ACEs, and their interaction on the primary outcomes while controlling for other variables. Covariates included in models were anxiety (subscale of the DSM-5 Self-rated Level 1 Cross- Cutting Measure), perceived social support, medical comorbidity (Cumulative Illness Rating Scale for Geriatrics) as well as age, gender, studying/working or not, antidepressant use count, TMS type (intermittent theta burst, iTBS or deep TMS) and number of treatment weeks (4 or 6). Results 24% (33/140) had probable PTSD. At baseline, those with probable PTSD had higher HAMD-17 (t = -3.5, p <0.001), higher anxiety (t = -2.6, p = 0.01), more ACEs (t = -5.8, p <0.0001), lower social support (t = 2.2, p = 0.03), and greater medical comorbidity (t = -3.6, p <0.001). In a linear regression model for HAMD-17 improvement, having more ACEs was associated with more improvement (t = 2.12, p = 0.036) whereas PTSD status had no significant effect (t = 1.86, p = 0.065) and there was no interaction between the two (t = -1.68, p = 0.096). In a logistic model for remission, higher ACE was associated with greater odds of remission (OR 1.4, z = 3.0, p = 0.003), whereas PTSD status had no effect (z = 0.08, p = 0.93) and no interaction was found (z = -1.14, p = 0.255). Discussion & Conclusion Though probable PTSD status was associated with higher baseline depression scores among civilians receiving rTMS for depression, it did not significantly impact improvement in depression symptoms or remission. These results suggest there is benefit to the use of rTMS (including iTBS and deep TMS) for civilians with depression even when there are concurrent PTSD symptoms and/or a history of childhood adversity. References [1]Yesavage JA, Fairchild JK, Mi Z, Biswas K, Davis-Karim A, Phibbs CS, et al. Effect of Repetitive Transcranial Magnetic Stimulation on Treatment-Resistant Major Depression in US Veterans: A Randomized Clinical Trial. JAMA Psychiatry 2018;75:884. https://doi.org/10.1001/jamapsychiatry.2018.1483. [2]Hernandez MJ, Reljic T, Van Trees K, Phillips S, Hashimie J, Bajor L, et al. Impact of Comorbid PTSD on Outcome of Repetitive Transcranial Magnetic Stimulation (TMS) for Veterans With Depression. J Clin Psychiatry 2020;81. https://doi.org/10.4088/JCP.19m13152. [3]Brigido S, Bozzay M, Philip NS. Posttraumatic Stress Disorder Symptom Severity Does Not Predict Depression Improvement, but May Impact Clinical Response and Remission. J Clin Psychiatry 2021;82. https://doi.org/10.4088/JCP.20l13751.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».