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Background:
A history of adverse childhood experiences (ACEs) is known to be associated with poorer depression treatment outcomes. It is unknown how ACEs impact outcomes from Transcranial Magnetic Stimulation (TMS) treatment for depression.
Objective:
Assess whether a history of ACEs impact depression outcomes in patients receiving high frequency rTMS targeted primarily to the left dorsolateral prefrontal cortex.
Methods:
A retrospective analysis of naturalistic treatment data was performed on patients who received rTMS for MDD at Sunnybrook Health Sciences Centre. Patients received either Deep TMS or intermittent theta burst stimulation (iTBS). Data from 99 patients was analyzed.
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.
Results:
Patients had an average of 2.4 ACEs. No significant differences in outcomes were found between Deep TMS or iTBS. 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.
Conclusions:
ACE scores may lead to a steeper early reduction in HAMD-17, but did not otherwise affect depression outcomes. Presence of high levels of ACEs should not alter consideration of rTMS for depression.
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