Bilateral Repetitive Transcranial Magnetic Stimulation In The Treatment Of Non-suicidal Self-injury In Depressed Adolescents

Background:In recent years,the incidence of suicidal self-injury（NSSI）is increasing,and it has serious effects on adolescents’body and mind.This behavior is repeated in most cases and can eventually lead to suicide.Currently,antidepressants are commonly used in the treatment of NSSI behavior,but some antidepressants have been shown to increase the risk of suicide in adolescents.Although psychotherapy is the first choice for adolescent depression patients and NSSI behavioral therapy,most patients cannot adhere to it due to the long course of treatment,slow onset and high cost.As a result,repetitive transcranial magnetic stimulation（r TMS）,a physical,non-invasive treatment,is increasingly widely used in behavioral therapy of NSSI in adolescents.In order to explore the effects of bilateral r TMS therapy on depressive mood and NSSI behavior in adolescents with depression,this study was conducted to provide a new theoretical basis for clinical treatment.Method:In this study,a total of 60 adolescents with depression who met the diagnostic criteria of ICD-10 and were accompanied by NSSI behavior were recruited and randomly divided into two groups.The control group was treated with simple drug therapy for 8weeks.The study group received drug therapy combined with r TMS for 4 weeks,then stopped r TMS after 4 weeks and continued drug therapy for 4 weeks.Both groups were evaluated and recorded by the General Situation Survey Scale,the Hamilton Depression Scale（HAMD）,the Self-rating Depression Scale（SDS）,and the Adolescent Nonsuicidal Self-Injury Behavior and Functioning Scale（ANSSIQ）before treatment.HAMD,SDS,ANSSIQ were evaluated in the two groups after 4 and 8 weeks of treatment.HAMD is a commonly used scale to judge the efficacy of depression.If the reduction rate of HAMD is≥75%,it is considered to be cured,74-50%is significantly effective,and 49-25%is effective.25%is invalid.SPSS 26.0 software was used for statistical analysis,p<0.05was statistically significant.Results:（1）There was no significant difference in general demographic data between the two groups（age:t=-1.248,p=0.217;gender:χ²=1.200,p=0.273;nationality:χ²=0.268,p=0.605;household registration:χ²=0.480,p=0.488;education:χ²=0.594,p=0.838;medical history:z=-1.916,p=0.055;family history:χ²=0.144,p=0.704）.There was no difference in dosage between the two groups（t=-0.447,p=0.656>0.05）.（2）HAMD score:HAMD scores were not different at baseline when the two groups were compared between the two groups,with statistically significant differences at weeks 4and 8（F₀=0.899,p₀=0.347;F₄=61.734,p₄<0.001;F₈=54.221,p₈<0.001）.HAMD scores decreased significantly over time in both groups when compared within the group（Study group:F=233.112,p<0.001;Control group:F=157.515,p<0.001）.HAMD scores in the study group showed significant differences between 0 and 4 weeks after treatment,4 and8 weeks,0 and 8 weeks（p<0.001、p<0.001、p<0.001）,HAMD scores of control group showed significant differences between 0 and 4 weeks after treatment,4 and 8 weeks,0and 8 weeks（p<0.001、p<0.001、p<0.001）.（3）SDS score:SDS scores were not different at baseline when the two groups were compared between the two groups,with statistically significant differences at weeks 4and 8(（F₀=0.257,p₀=0.614;F₄=11.933,p₄=0.001;F₈=14.824,P₈<0.001）.SDS scores decreased significantly over time in both groups when compared within the group（Study group:F=300.230,p<0.001;Control group:F=243.242,p<0.001）.SDS scores in the study group showed significant differences between 0 and 4 weeks after treatment,4 and8 weeks,0 and 8 weeks（p<0.001、p<0.001、p<0.001）,HAMD scores of control group showed significant differences between 0 and 4 weeks after treatment,4 and 8 weeks,0and 8 weeks（p<0.001、p<0.001、p<0.001）.（4）ANSSIQ score:ANSSIQ scores were not different at baseline when the two groups were compared between the two groups,with statistically significant differences at weeks4 and 8（F₀=0.070,p₀=0.793;F₄=12.003,p₄=0.001;F₈=14.067,p₈<0.001）.ANSSIQ scores decreased significantly over time in both groups when compared within the group（Study group:F=46.529,p<0.001;Control group:F=37.883,p<0.001）.ANSSIQ scores in the study group showed significant differences between 0 and 4 weeks after treatment,4 and 8 weeks,0 and 8 weeks（p<0.001、p<0.001、p<0.001）,ANSSIQ scores of control group showed significant differences between 0 and 4 weeks after treatment,4 and 8weeks,0 and 8 weeks（p<0.001、p<0.001、p<0.001）.Conclusion:1.Both bilateral r TMS combined with Sertraline and sertraline alone can improve depressive mood and reduce the number of NSSI in adolescents with depression.2.Bilateral r TMS combined with medication can relieve depressive mood and reduce NSSI behavior in adolescents with depression more quickly than medication alone.3.Bilateral r TMS combined with drug therapy has better long-term efficacy in relieving depression and reducing self-injurious behavior.