Relationship of Childhood Trauma with Transcranial Magnetic Stimulation Outcome for Depression

Abstract

Background: Childhood trauma has lasting effects on treatment outcomes for many illnesses including major depressive disorder (MDD) but the relationship with transcranial magnetic stimulation (TMS) is unknown.Methods: Childhood Trauma Questionnaire (CTQ), a questionnaire to assess severity and type of childhood trauma, was collected in a naturalistic outpatient setting from patients receiving TMS for treatment resistant MDD. Inventory of Depressive Symptomatology Self Report (IDS-SR) was used to assess depression symptom severity, clinical response and remission. Standard treatment was given at 10 Hz stimulation to the dorsolateral left prefrontal cortex at 120% maximum intensity relative to their motor threshold for 3000-4000 pulses/daily for six weeks.Results: 117 patients receiving TMS completed CTQ. More severe trauma showed less improvement after TMS as seen via a negative correlation between IDS-SR %change and CTQ total score (r=-.251, p<0.01). Specifically, less improvement correlated with degree of physical abuse (r=-.245, p<0.01) and physical neglect (r=-.251, p<0.01). Non-responders had significantly worse scores in physical abuse (p<.01), sexual abuse (p<.05), and physical neglect (p<.05) compared to responders. Significant chi-square associations between physical neglect and non-response (χ=8.623, p<0.05); and sexual abuse and non-remission (χ=9.214, p<0.05) were present.Conclusion: Our data show that certain types of trauma may have more impact on TMS outcomes than others. Based on these results, future studies examining the possible biological pathways and mechanisms contributing to the differences in severely depressed patients with and without certain types of childhood trauma could lead to a more personalized treatment algorithm leading to improved efficacy of TMS.Conflicts of Interest: None to reportFunding: This work was supported by grants from the National Institute of Mental Health (NIMH) R25MH101076 (Dr. AM Fukuda) and P20GM130452 (E Tirrell & Dr. LL Carpenter), and by Butler Internal Funding. Background: Childhood trauma has lasting effects on treatment outcomes for many illnesses including major depressive disorder (MDD) but the relationship with transcranial magnetic stimulation (TMS) is unknown. Methods: Childhood Trauma Questionnaire (CTQ), a questionnaire to assess severity and type of childhood trauma, was collected in a naturalistic outpatient setting from patients receiving TMS for treatment resistant MDD. Inventory of Depressive Symptomatology Self Report (IDS-SR) was used to assess depression symptom severity, clinical response and remission. Standard treatment was given at 10 Hz stimulation to the dorsolateral left prefrontal cortex at 120% maximum intensity relative to their motor threshold for 3000-4000 pulses/daily for six weeks. Results: 117 patients receiving TMS completed CTQ. More severe trauma showed less improvement after TMS as seen via a negative correlation between IDS-SR %change and CTQ total score (r=-.251, p<0.01). Specifically, less improvement correlated with degree of physical abuse (r=-.245, p<0.01) and physical neglect (r=-.251, p<0.01). Non-responders had significantly worse scores in physical abuse (p<.01), sexual abuse (p<.05), and physical neglect (p<.05) compared to responders. Significant chi-square associations between physical neglect and non-response (χ=8.623, p<0.05); and sexual abuse and non-remission (χ=9.214, p<0.05) were present. Conclusion: Our data show that certain types of trauma may have more impact on TMS outcomes than others. Based on these results, future studies examining the possible biological pathways and mechanisms contributing to the differences in severely depressed patients with and without certain types of childhood trauma could lead to a more personalized treatment algorithm leading to improved efficacy of TMS. Conflicts of Interest: None to report Funding: This work was supported by grants from the National Institute of Mental Health (NIMH) R25MH101076 (Dr. AM Fukuda) and P20GM130452 (E Tirrell & Dr. LL Carpenter), and by Butler Internal Funding.