Investigation of predictive factors in response to repetetive transcranial magnetic stimulation (RTMS) therapy in depressive disorder

Objective: The prevalence of depressive disorder (MDD) is increasing with each passing year; it is a mental illness that causes a high level of loss of functionality in almost every area of the person. One of the prominent options in the treatment of treatment-resistant depression is Repetitive Transcranial Magnetic Stimulation (rTMS), which is a neuromodulatory method. Personalized medicine approach has gained importance in the field of psychiatry in recent years. In this context, it becomes more and more important to determine the clinical and biological predictors of the efficacy levels achieved by various treatment methods for each psychiatric disease and patient. In our study, we aimed to examine, with a retrospective approach, to what extent different demographic and clinical features are predictive of remission in the treatment of depression with rTMS. Method: Patients who applied to the Transcranial Magnetic Stimulation (TMS) Polyclinic of the Department of Mental Health and Diseases of Akdeniz University between February 01, 2019 and June 01, 2020, who were diagnosed with depressive disorder according to DSM-5 diagnostic criteria and were treated with rTMS, were included in the study (n=120). These patients were referred to TMS treatment because they did not respond adequately to at least one antidepressant drug treatment despite being administered for a sufficient duration and dose. In the study, clinical and demographic characteristics obtained from the medical records of patients who completed at least 20 sessions of rTMS treatment with remission were investigated. For this purpose, the patients were divided into two groups as those in remission and not in remission, and after comparing them in terms of the mentioned characteristics, predictors of remission were analyzed with a regression analysis model. Discussion and conclusion: These findings may be important for personalized medicine applications in personalized psychiatry. Knowing the predictive features of remission may provide important advantages such as selecting the appropriate patient for TMS treatment and predicting the effectiveness of treatment early in the treatment process. In order to confirm the accuracy of all these results, comparative studies with larger samples and longitudinal follow-up are needed.