262. Impact of adverse childhood experiences on brain stimulation outcomes for depression
TL;DR
While ACEs were prevalent among patients with MDD receiving brain stimulation treatment, the presence of more ACEs was not associated with poorer outcomes with acute high frequency rTMS treatment or with SCC-DBS treatment with long-term follow-up.
Abstract
Abstract Background Adverse childhood experiences (ACEs) predict poorer response to treatments for major depressive disorder (MDD) including medications, psychotherapy, and their combination. A score of 4 or more ACEs is commonly associated with poorer health outcomes overall. The impact of ACEs on brain stimulation methods, whether non-invasive like repetitive transcranial magnetic stimulation (rTMS) or invasive like deep brain stimulation (DBS) is less well-characterized. Aims & Objectives We aim to characterize the prevalence of ACEs in patients with depression receiving rTMS or DBS and whether having a high burden of ACEs impacts clinical outcomes. Method Retrospective analyses were conducted on 133 patients with MDD who received high frequency rTMS to the left dorsolateral prefrontal cortex and 56 patients with MDD who received DBS of the subcallosal cingulate area (SCC-DBS). The ACE-10 questionnaire was used to quantify categories of ACEs and the 17-item Hamilton Depression Rating Scale (HAMD-17) was used to measure depressive symptoms over time. Mixed effects models were used to probe the impact of ACEs on change in HAMD-17 scores over time. Results rTMS patients reported on average 2.4 ACEs with 38/133 (29%) reporting 4 or more ACEs. ACE score did not significantly impact change in HAMD-17 scores during rTMS treatment (chi2 = 1.34, p = 0.51). Regardless of ACE score, depression scores were significantly decreased by 2 weeks of high frequency treatment (b = -6.2, SE = 0.65, p < 0.001) and continued to decrease into 4 weeks of treatment. DBS patients reported on average 3.3 ACEs with 25/56 (45%) reporting 4 or more ACEs. ACE score did not significantly impact change in HAMD-17 scores over time with SCC-DBS (chi2 = 1.13, p = 0.77). Depression scores were significantly lower than baseline by 12 months post-DBS surgery (b = -11.8, SE 2.1, p < 0.001) and remained so into 24 and 36 months. Discussion & Conclusions While ACEs were prevalent among patients with MDD receiving brain stimulation treatment, the presence of more ACEs was not associated with poorer outcomes with acute high frequency rTMS treatment or with SCC-DBS treatment with long-term follow-up.