Can psychological features predict antidepressant response to rTMS? A Discovery-Replication approach

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Psychology

Background:

• Repetitive transcranial magnetic stimulation (rTMS) is a treatment for major depressive disorder (MDD).
• Predictors of rTMS treatment response in MDD remain incompletely understood.
• The role of psychological measures in predicting rTMS outcomes requires further investigation.

Purpose of the Study:

• To investigate psychological measures as predictors of rTMS treatment response in MDD patients.
• To evaluate the robustness and clinical relevance of potential predictors.
• To assess the utility of psychological assessments in guiding rTMS therapy.

Main Methods:

• An open-label, multi-site study involving 196 MDD patients, divided into discovery and replication samples.
• Patients received either low-frequency (1 Hz) or high-frequency (10 Hz) rTMS targeting the dorsolateral prefrontal cortex.
• Baseline and follow-up assessments included the Beck Depression Inventory (BDI), Neuroticism, Extraversion, Openness Five-Factor Inventory, Depression, Anxiety, and Stress Scale, and BDI subscales.

Main Results:

• Univariate analyses indicated that non-responders to rTMS exhibited higher baseline anhedonia scores.
• Baseline anhedonia scores showed a negative correlation with the percentage change in total BDI over time, a finding that was replicated.
• Anhedonia demonstrated only marginal predictive value for rTMS response, with positive and negative predictive values not reaching clinical relevance.

Conclusions:

• Higher baseline anhedonia scores are associated with non-response to rTMS in MDD.
• Anhedonia alone is not a sufficiently reliable or clinically relevant predictor of rTMS treatment success.
• Current psychological measures lack the predictive power for clinically relevant stratification of MDD patients undergoing rTMS therapy.