Clinical Efficacy Of RTMS In The Treatment Of First-episode Depression With NSSI And Its Magnetic Resonance Spectroscopy Analysis

Objective: 1.To explore the content of γ-aminobutyric acid(GABA)and Glutamic acid(GLU)in the medial prefrontal cortex(m PFC)of the brain and their correlation with depressive symptoms and Non-suicidal self-injury(NSSI)behavior in patients with depression with NSSI by magnetic resonance spectroscopy(MRS).2.To explore the changes of depressive symptoms,NSSI behaviors and the content of GABA and GLU in m PFC after repetitive trans Cranial magnetic stimulation(r TMS)treatment,and the correlation between depressive symptoms,NSSI behaviors and the content of GABA and GLU.Methods: 103 patients with first-episode depressive disorder with NSSI behavior(diagnosed as DSM-5)were included.Hamilton depression rating scales(HAMD),self-rating depression scale(SDS)and adolescent non-suicidal self-injury assessment questionnaire(ANSSIQ)were used to evaluate the depressive symptoms and the severity of NSSI behavior.After that,MRS examination was performed,and MRS data were acquired and post-processed using J-difference edited point-resolved spectroscopy(MEGA-PRESS)technology and Gannet software,and the contents of GABA and GLU in m PFC of patients’ brains were measured.To analyze the correlation between depression symptoms and the severity of NSSI behavior with the contents of GABA and GLU in m PFC.On this basis,35 patients were randomly divided into the study group and the control group for 10 days of treatment.Both groups were treated with conventional antidepressants,while the former was treated with both antidepressants and r TMS.After treatment,the HAMD,SDS and ANSSIQ scales were evaluated again and MRS examination was conducted.The scores of HAMD,SDS and ANSSIQ scales and the differences of GABA and GLU contents in brain m PFC before and after r TMS treatment were compared.The changes of HAMD,SDS and ANSSIQ scales(d HAMD,d SDS and d ANSSIQ)and GABA and GLU contents in brain m PFC(d GABA and d GLU)before and after treatment were compared.Results: 1.Before treatment,there was no significant difference between the two groups in various demographic data,HAMD,SDS,ANSSIQ scores,and GABA and GLU contents in m PFC(all P>0.05),indicating that they were comparable.There was a positive correlation between HAMD,SDS and ANSSIQ scores at baseline(r=0.413,P=0.025;r=0.356,P=0.036);There was a negative correlation between HAMD,SDS and ANSSIQ scores and GABA content in m PFC(r=-0.423,P=0.032;r=-0.312,P=0.012;r=-0.497,P=0.018),and there was a positive correlation with GLU content(r=0.326,P=0.013;r=0.285,P=0.038;r=0.355,P=0.024).2.After treatment,GABA in m PFC of patients in the research group was in Creased(t=-3.045,P=0.015),GLU content was de Creased(t=2.566,P=0.022),and HAMD,SDS and ANSSIQ scores were all de Creased(t=3.797,P<0.001;t=3.054,P<0.001;t=2.322,P=0.017);In the control group,the contents of GABA and GLU in m PFC were not significantly different before and after treatment(all P>0.05),and the scores of HAMD,SDS and ANSSIQ were all de Creased(t=2.562,P=0.013;t=3.024,P=0.016;t=5.134,P<0.001).Further comparison between the two groups showed that the HAMD,SDS and ANSSIQ scores of patients in the research group were lower than those in the control group(t=-2.923,P=0.001;t=-2.265,P=0.012;t=-3.533,P<0.001),higher GABA content in m PFC than in the control group(t=1.863,P=0.036),and lower GLU content than in the control group(t=-3.152,P=0.002).3.The changes of GABA in the patients in the study group before and after treatment were negatively correlated with the scores of HAMD,SDS and ANSSIQ(r=0.377,P=0.022;r=0.332,P=0.034;r=0.424,P=0.013),the change of GLU is positively correlated with the reduction of HAMD,SDS and ANSSIQ(r=0.313,P=0.015;r=0.274,P=0.025;r=0.365,P=0.026).The results of multiple linear regression analysis show that among the two independent variables d GABA and d GLU,d GLU has a positive effect on d HAMD and d ANSSIQ(b=1.01\0.855,P<0.05),while d GABA has a negative effect on d SDS(β=-6.889,P<0.05).Conclusion: The contents of GABA and GLU in brain m PFC of depression patients with NSSI behavior are related to the severity of depression symptoms and NSSI behavior.Low-frequency r TMS therapy on the right DLPFC can be used for the treatment of depressed patients with NSSI behavior.After treatment,the depressive symptoms of patients are alleviated,and the self-injury ideas and behaviors are reduced.These changes may be related to the in Crease of GABA content and the de Crease of GLU content in brain m PFC during treatment.