Objective To explore the preliminary value of 1H-MRS in predicting the prognosis of adolescents with depressive disorder before receiving repetitive transcranial magnetic stimulation (rTMS), so as to improve the targeting and effectiveness of rTMS treatment. Methods A total of 31 adolescents with depressive disorder treated at Urumqi Youai Hospital from May 2024 to March 2025 were recruited.All patients received standardized sertraline monotherapy to control for confounding drug effects.Before and after 2 weeks of rTMS treatment, the 24-item Hamilton Depression Scale (HAMD-24) was used to assess symptom severity, and 1H-MRS was applied to detect hippocampal levels of choline (Cho), N-acetylaspartate (NAA), and creatine (Cr).Patients were classified into an effective group (reduction rate ≥50%) or an ineffective group based on HAMD score reduction. Results There were statistically significant differences between the two groups in the sleep disturbance factor (t=-2.144, P<0.05) and hopelessness factor (t=-2.053, P<0.05) of HAMD, as well as the Cho/Cr ratio in the hippocampus (t=-2.935, P<0.05).In the logistic regression analysis, the Cho/Cr ratio (OR=1.62, 95%CI:1.00 - 2.63) had a statistically significant impact on the antidepressant efficacy of rTMS (P<0.05).After constructing the ROC curve, the area under the curve (AUC) of the Cho/Cr ratio was 0.735 (P<0.05).According to the maximum Youden index, the optimal cut-off value was calculated as 1.13, with a sensitivity of 94.7% and a specificity of 58.3%.This indicates that among adolescent patients with depressive disorder receiving rTMS treatment, those with a Cho/Cr ratio greater than 1.13 may have a better response to rTMS treatment. Conclusions The hippocampal Cho/Cr ratio may serve as a potential predictive indicator for rTMS efficacy in adolescents with depressive disorder, providing preliminary evidence for individualized clinical treatment.
Key words
adolescent /
cerebral metabolites /
repetitive transcranial magnetic stimulation /
depressive disorder
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