B – 61 Age and PTSD Subtypes as Predictors of TMS Treatment Outcomes in Veterans with Comorbid PTSD and Depression

Abstract Objective To understand factors that may influence treatment outcomes of rTMS, the aim of this study was to examine the role of age and PTSD subtypes on clinical response and remission in veterans with comorbid PTSD and depression. Method Participants (n = 567) included in this study were veterans with comorbid PTSD and major depression undergoing rTMS for treatment resistant depression (TRD) and enrolled in a cohort study through the VA Palo Alto Healthcare System. Data variables included demographic information (age, gender, race/ethnicity, and education), the PTSD Checklist for DSM-5 (PCL-5), and the Patient Health Questionnaire (PHQ-9). The PHQ-9 was administered before and after treatment to determine clinical outcomes. Four PTSD subtypes were determined through prior analyses: intrusive-avoidant type, hyperarousal type, hypervigilant type, detached type. Generalized-linear regression was conducted to examine the relationship between age and PTSD subtype on clinical outcomes. Results After controlling for gender, education, race/ethnicity, results indicated a significant interaction between age and PTSD subtype on clinical response (p = .006) but not clinical remission (p = .179). Specifically, compared to those with the intrusive-avoidance subtype of PTSD, the hyperarousal and hypervigilant type were significantly less likely to experience clinical response (ps < .05). Conclusion These results suggest that age and type of PTSD may influence rTMS treatment response for TRD. This highlights the importance of considering symptom profiles or clusters as well as age in comorbid PTSD and depression as they may inform treatment outcomes. Further research on understanding these profiles and predictors of TMS outcomes is warranted.