Depressive symptom trajectories with prolonged rTMS treatment

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Research

Background:

• Repetitive transcranial magnetic stimulation (rTMS) is a treatment for major depressive episodes (MDE).
• Extended rTMS treatment courses may offer benefits for certain patient groups.
• Identifying response trajectories is crucial for optimizing treatment duration.

Purpose of the Study:

• To identify distinct trajectories of rTMS response in patients with MDE.
• To determine which response trajectories benefit most from prolonged rTMS treatment.
• To explore baseline predictors of different response patterns.

Main Methods:

• Group-based trajectory modeling was applied to a naturalistic dataset.
• Patients received sequential bilateral rTMS to the dorsolateral prefrontal cortex (up to 51 sessions).
• PHQ-9 scores were analyzed, and multinomial logistic regression explored baseline characteristics' association with group membership.

Main Results:

• Four distinct rTMS response trajectories were identified among 324 participants.
• The "linear response, extended course" group (22.5%) showed significant clinical improvement with prolonged treatment.
• Greater baseline depressive symptoms were associated with linear response and non-response.

Conclusions:

• Distinct response trajectories to rTMS in MDE patients were confirmed.
• Prolonged rTMS treatment courses appear beneficial for a subset of patients.
• Patients with higher initial symptom severity and linear early response may benefit most from extended treatment.