| Objective: To investigate the effects of low-frequency repetitive transcranial magnetic stimulation on depression,anxiety symptoms and suicidal ideation in adolescents with depression and its safety,and to provide more references for the treatment and research of adolescents with depression.Methods: Sixty patients with adolescent depression,aged 13～18 years old,attending the Department of Mental Health,Second Hospital of Lanzhou University,were selected from 2021.6 to 2021.12 and randomly divided into 30 cases in the real stimulation group and30 cases in the sham stimulation group according to the random number table method,with low frequency（1 Hz）repetitive transcranial magnetic stimulation(the real stimulation group was given low-frequency（1 Hz）repetitive transcranial magnetic stimulation（rTMS）combined with selective serotonin reuptake inhibitors（SSRIs）sertraline hydrochloride,and the sham stimulation group was given low-frequency rTMS pseudo-stimulation combined with sertraline hydrochloride at admission（T1）,week 2（T2）and week 4（T3）after treatment.The Beck Depression Inventory-Ⅱ Of Chinese version（BDI-Ⅱ-C）,Self-Rating Anxiety Scale（SAS）,and Positive and Negative Suicide Ideas Scale for Adolescents（PNSI）were assessed at the end of T1,T2,and T3.The Positive and Negative Suicide Ideation Inventory（PANSI）was used to assess the depression and anxiety symptoms and suicidal ideation in both groups;The study population was Full Analysis Set（FAS）data,and data were analyzed using SPSS26.0 software with statistical methods such as t-test or Mann-Whitney U test,repeated measures ANOVA,and chi-square test.Results: A total of 55 subjects were finally included in the FAS set,including 29 cases in the real stimulation group and 26 cases in the sham stimulation group,and the differences in general information（gender,age,ethnicity,living environment,education level,years of education,academic achievement,monthly family income,relationship status with family members,and disease duration）between the two groups were not statistically significant（P>0.05）;During the experimental observation period lasting four weeks,the scores of BDI-Ⅱ-C,SAS,and PANSI of the two groups were analyzed within and between groups and the trends of changes were as follows:（1）the differences between the BDI-Ⅱ-C scores of the real stimulation group and the sham stimulation group before and after treatment were statistically significant when compared within the group（P<0.01）,and the differences between the groups before and after treatment at each time point were not statistically significant（P>0.05）;However,from the line graph,the scores of both groups showed a decreasing trend,and the decrease in the first two weeks was significantly greater than that in the last two weeks,and at the same time point,the decrease in the true stimulation group was greater than that in the sham stimulation group（greater slope）.（2）The differences of SAS score were statistically significant（P<0.01）before and after treatment when comparing within the two groups,and there were no statistically significant differences（P>0.05）at each time point before and after treatment when comparing between groups;However,from the score line graph,the scores of the real stimulation group showed a continuous decreasing trend,and the decrease in the first two weeks was significantly greater than that of the second two weeks,while the scores of the sham stimulation group decreased significantly in the first two weeks and showed a slight increase in the second two weeks.In addition,the score of the real stimulation group decreased significantly more than that of the sham stimulation group in the first two weeks（greater slope）.（3）The intra-group and inter-group differences between the two groups of PANSI scores before and after treatment were not statistically significant（P>0.05）,but from the score line graph,the scores of the real stimulation group showed a continuous decreasing trend,and the decrease was significantly greater in the first two weeks than in the second two weeks,while the scores of the sham stimulation group increased rather than decreased in the first two weeks,and then decreased islightly in the second two weeks,but were still higher than the baseline period level.（4）During the study period,no serious side effects were reported.Only two subjects in the real stimulation group reported mild headache discomfort,but it resolved on its own after rest on the day of treatment.Conclusions:（1）There is no effective evidence that low-frequency rTMS can significantly improve depression and anxiety symptoms in adolescents with depression,but it has some potentiation effect in the early stage of treatment,which can accelerate the improvement of depression and anxiety symptoms in patients.（2）Low-frequency rTMS has a facilitative effect on the reduction of suicidal ideation in adolescents with depression.（3）From the study as a whole,low-frequency rTMS treatment was safe and well tolerated for adolescent depression,but the potential long-term effects on adolescents with depression still need further study. |
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