Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 30:7067437251342277.
doi: 10.1177/07067437251342277. Online ahead of print.

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

Enoch Ng  1   2   3 , Sean M Nestor  1   2   3 , Jennifer S Rabin  2   3   4   5 , Clement Hamani  2   3   6 , Nir Lipsman  2   3   6 , Peter Giacobbe  1   2   3
Affiliations

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

Enoch Ng et al. Can J Psychiatry. .

Abstract
in English, French

Objectives: The 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.

Methods: A 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).

Results: 29/133 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.

Conclusions: Our findings suggest neither co-morbid PTSD symptoms nor distal childhood adversities should preclude patients with MDD from receiving rTMS for depression.

Objectifs: L’incidence des symptômes du trouble de stress post-traumatique (TSPT) comorbide sur les résultats antidépresseurs de la stimulation magnétique transcrânienne répétitive (SMTr) chez les personnes atteintes d’un trouble dépressif majeur (TDM) est mal étudiée. Nous avons cherché à comprendre si les symptômes proximaux du TSPT interagiraient avec les traumatismes distaux et influenceraient les résultats après un traitement par SMTr.

Méthodes: Une analyse rétrospective a été effectuée sur 133 patients atteints de TDM qui ont reçu une SMTr à haute fréquence en mode ouvert dans le cortex préfrontal dorso-latéral gauche pendant 4 semaines. Le TSPT probable a été défini comme un score ≥ 4 à l’écran du Primary Care PTSD Screen for DSM-5. Les traumatismes distaux ont été quantifiés à l’aide du questionnaire ACE-10 (expériences traumatiques de l’enfance). Les principaux critères de jugement étaient l’amélioration des scores sur l’échelle de dépression de Hamilton à 17 éléments (HAMD-17) entre le début de l’étude et la 4e semaine, ainsi qu’une rémission (HAMD-17 ≤ 7) et une réponse (amélioration > 50% par rapport au début de l’étude).

Résultats: 29/133 présentaient un TSPT probable. Les patients qui présentaient un TSPT probable présentaient plus d’expériences traumatiques de l’enfance, ainsi que des scores plus élevés de dépression, d’anxiété et de comorbidité médicale. Ni l’état de TSPT probable ni son interaction avec les expériences traumatiques de l’enfance n’ont eu une incidence importante sur la dépression. Toutefois, le fait d’avoir connu plus d’expériences traumatiques de l’enfance était associé à de plus grandes chances de rémission et de réponse.

Conclusions: Nos résultats indiquent que ni les symptômes du TSPT comorbide ni les expériences traumatiques de l’enfance ne devraient empêcher les patients atteints de TDM de recevoir une SMTr pour cause de dépression.

Keywords: adverse childhood experiences; depression; major depressive disorder; neuromodulation; posttraumatic stress; rTMS; repetitive transcranial magnetic stimulation.

Plain language summary

Repetitive transcranial magnetic stimulation for civilian patients with depression and posttraumatic stress symptomsPlain Language SummaryTo date, most research studies investigating whether posttraumatic stress-related symptoms can impact the effectiveness of repetitive transcranial magnetic stimulation (rTMS) have been conducted on military veterans. Here, we studied depressed civilians with no military experience that received transcranial magnetic stimulation for depression. Over 1 in 5 screened positive for probable post-traumatic stress disorder (PTSD). Probable PTSD was associated with higher symptoms of depression and anxiety prior to the start of treatment. However, probable PTSD did not lead to poorer depression outcomes from rTMS treatment. Probable PTSD and childhood adversity also did not interact to lead to poorer depression outcomes from rTMS treatment. These results suggest depressed adults with current PTSD-related symptoms and/or a history of childhood adversity can benefit from receiving rTMS for depression.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Models of HAMD-17 scores over time with (a) the dichotomous PC-PTSD-5 variable and (b) a continuous PC-PTSD-5 variable (with predicted HAMD-17 scores shown for three levels of PC-PTSD-5 score for illustrative purposes). PTSD, posttraumatic stress disorder.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119-138. - PMC - PubMed
    1. Patten SB, Williams JVA, Lavorato DH, et al. The prevalence of major depression is not changing. Can J Psychiatry. 2015;60(1):31-34. - PMC - PubMed
    1. Whiteford HA, Ferrari AJ, Degenhardt L, et al. The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PLoS One. 2015;10(2):e0116820. - PMC - PubMed
    1. Shalev AY, Freedman S, Peri T, et al. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry. 1998;155(5):630-637. - PubMed
    1. Nanni V, Uher R, Danese A. Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J Psychiatry. 2012;169(2):141-151. - PubMed

LinkOut - more resources