| BackgroundRecent years,depression,which is one of the most severe psychiatric disorders,has been well-recognized.The symptoms include not only low mood,reduced interest,lack of pleasure,but also the useless,helpless,hopeless psychological feelings.Future thinking,which is regarded as a cognitive process that people casting themselves into the future,is crucial for maintaining individuals'mental health,as well as the treatment and rehabilitation of depression.Repetitive transcranial magnetic stimulation(rTMS)is a widely-used physiotherapy method in the treatment of depression.However,there is no rTMS intervention study on the abnormal future thinking of depression,which is worth further exploration.Objective1.Identify the deficits of future thinking in depression,as compared with healthy control;2.Explore whether rTMS shows significant effect on the correction of future thinking abnormalities;3.Test if there is a positive correlation between hopelessness difference(pre-treatment minus post-treatment)and future thinking difference(post-treatment minus pre-treatment).Methods101 patients with depression from the Institute of Psychiatric Disease Prevention and Control of the 91st Central Hospital of the People's Liberation Army(from June 2017 to September 2018)were randomly divided into study group and control group.The study group(n=51)received rTMS(10 Hz)stimulation at dorsolateral prefrontal cortex(DLPFC)combined with oral administration of mirtazapine.In the control group(n=50),the sham rTMS stimuli were given together with the oral mirtazapine treatment.For sham rTMS,the plane of the stimulation coil was at an angle of 90°to the scalp,and the edge of the coil was tangent to the head,resulting in ineffective stimulation.All the rTMS stimulation intensity was 100%of the motor threshold(Moter Threshold,MT).During the treatment,rTMS was performed once a day,5 consecutive days a week,so the 4 weeks treatment included 20 times totally.Every rTMS treatment continues for 20 minutes.Depression symptoms were assessed by applying the Hamilton Depression Rating Scale(HAMD-24)before and 4 weeks after treatment,respectively.The Beck Hopelessness Scale(BHS)was used to measure the change in hopelessness of the patient.The future thinking test(FTT)was used to measure the participants'future thinking performance.The symptom scale(TESS)is used to assess side effects that occur during the treatment.The effects of the study group and the control group,the sense of hopelessness,and the characteristics of future thinking were compared.All data were input into the computer,and analyzed using SPSS19.0.The mixed-design ANOVA,repeated measures ANOVA,t-test,Chi-square test,and Pearson correlation analysis were chose based on the task design and characteristics of our data.Results1.There is no significant difference in gender(?~2=0.884,P=0.643),age(F(2,148)=0.625,P=0.537)or education level(F(2,148)=1.675,P=0.191)among the study group,control group and normal group.There is no statistical difference in the course of disease(t(99)=0.705,P=0.483),the number of relapses(t(99)=1.303,P=0.196)or the drug dose(t(99)=0.461,P=0.646)between study group and control group.2.There was no significant difference in the HAMD scores between the study group and control group before treatment(t(99)=0.265,P=0.792).There was a significant difference in the HAMD score between the study group and control group after 4 weeks of treatment(t(99)=5.279,P<0.001).All P values of the t-test were corrected using Bonferroni correction.3.There was no significant difference in the hopelessness(BHS)scores between the study group and the control group before treatment(t(99)=0.620,P=0.537).After 4 weeks of treatment,the difference of the hopelessness between the study group and the control group was significantly different(t(99)=4.071,P<0.001).All P values of the t-test were corrected using Bonferroni correction.4.The patient group and normal group completed the future thinking tasks at the time of admission.The positive anticipation numbers of the patient group were significantly lower than the normal group(t(149)=12.064,P<0.001).In addition,the negative anticipation numbers of the patient group were significantly higher than the normal group(t(149)=9.103,P<0.001).After 4 weeks of treatment,the positive anticipation numbers of the study group and control group increased,and were significantly greater than the same groups'pre-treating numbers(t(50)=10.704,P<0.001;t(49)=5.462,P<0.001),while the negative anticipation numbers decreased,and were significantly less than the same groups'pre-treating numbers(t(50)=7.471,P<0.001;t(49)=4.382,P<0.001).In addition,after treatment,the positive anticipation numbers of the study group were higher than the control group(t(99)=4.02,P<0.001);the negative anticipation numbers of the study group were lower than control group(t(99)=2.483,P=0.030).5.There was a significant positive correlation between anticipation difference(post-treatment minus pre-treatment)and HAMD difference(pre-treatment minus post-treatment)for positive(r=0.512,P<0.001)and negative(r=0.351,P=0.012)future thinking in study group.The control group showed similar results as the study group(positive anticipation:r=0.390,p=0.005;negative anticipation:r=0.293,P=0.041),however,the correlation coefficients are lower than the study group.6.There was a significant positive correlation between anticipation difference(post-treatment minus pre-treatment)and hopelessness difference(pre-treatment minus post-treatment)for positive(r=0.461,P<0.001)and negative(r=0.333,P=0.018)future thinking in study group.The control group only showed significant positive correlation between positive anticipation difference and hopelessness difference(r=0.352,P=0.013),not for negative anticipation(r=0.222,P=0.125).7.The incidence of adverse events in the study and control groups was 23.53%and22.00%,respectively.There was no significant difference by chi-square test(?~2=0.034,P=0.855).All adverse events disappeared or turned tolerable after symptomatic treatment.And no one fell off due to serious adverse events.Conclusions1.Before the treatment,future thinking of patients with depression is characterized by a decrease in positive anticipations and an increase in negative anticipations.2.The combination of rTMS and mirtazapine is more effective than mirtazapine alone in reducing the patient's hopelessness feeling,increasing the positive anticipations of patients'future thinking and reducing the negative anticipations of patients'future thinking.3.The future thinking changes may be used as an indicator for the treatment of depression. |
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